Lawrence John E, Fountain Daniel M, Agius Mark
Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, UK,
Psychiatr Danub. 2014 Nov;26 Suppl 1:269-72.
Encephalitis associated with antibodies targeted against the N-methyl-D-aspartate (NMDA) receptor is increasingly recognised as a major cause of an acute presentation of organic psychosis. Misdiagnosis and subsequent inappropriate referral to psychiatric services is common and avoidable. This review focuses on addressing this issue in the acute setting.
The authors present a review of existing literature relating to the pathophysiology and presentation of anti-NMDA receptor encephalitis, prior to proposing a management pathway avoiding delays to treatment incurred through misdiagnosis or inappropriate referral.
Acute care physicians should have a low threshold for suspecting anti-NMDA receptor encephalitis in any patient presenting with acute psychosis in the context of non-specific coryzal and constitutional symptoms in whom infective causes have been excluded. The presence of pleocytosis and reduced protein in routine CSF analysis should further raise suspicion, and samples should be sent for immunohistochemical testing. Availability and efficiency of this testing is currently suboptimal.
与抗 N-甲基-D-天冬氨酸（NMDA）受体抗体相关的脑炎日益被认为是急性器质性精神病的主要病因。误诊以及随后不恰当地转诊至精神科服务机构的情况很常见且可避免。本综述着重于在急性情况下解决这一问题。
在提出一种避免因误诊或不恰当转诊而导致治疗延误的管理途径之前，作者对现有关于抗 NMDA 受体脑炎的病理生理学和临床表现的文献进行了综述。
对于任何在排除感染性病因后出现伴有非特异性鼻咽炎和全身症状的急性精神病患者，急性护理医生应保持较低的怀疑抗 NMDA 受体脑炎的阈值。常规脑脊液分析中出现细胞增多和蛋白降低应进一步提高怀疑度，并且应送检样本进行免疫组化检测。目前该检测的可及性和效率欠佳。
