Shahani Lokesh
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
BMJ Case Rep. 2015 Apr 29;2015:bcr2014208823. doi: 10.1136/bcr-2014-208823.
Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune disorder resulting in neurological and psychiatric symptoms. It is rare during pregnancy and treatment is extremely challenging as little data exist to guide management. A 26-year-old woman presented at 22 weeks of gestation with intermittent headache and an acute episode of bizarre behaviour and grandiose delusions resulting in hospitalisation. The patient was worked up for encephalitis and was found to have anti-NMDA receptor antibody in cerebrospinal fluid as well as in serum. She was initially treated with high-dose steroids but failed to improve clinically and serologically. She was then treated with plasmapheresis and showed clinical and serological response. She had a successful delivery at 37 weeks and the baby did not show serological evidence of disease. This case adds to the sparse literature of anti-NMDA receptor encephalitis during pregnancy and adds to the differential diagnosis of new onset psychiatric symptoms during pregnancy.
抗 N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种导致神经和精神症状的自身免疫性疾病。孕期罕见，由于几乎没有数据可指导管理，治疗极具挑战性。一名 26 岁女性在妊娠 22 周时出现间歇性头痛，并突发怪异行为和夸大妄想，遂住院治疗。对该患者进行了脑炎相关检查，发现其脑脊液和血清中均存在抗 NMDA 受体抗体。她最初接受了大剂量类固醇治疗，但临床症状和血清学指标均未改善。随后接受了血浆置换治疗，临床症状和血清学指标均有改善。她在 37 周时成功分娩，婴儿未显示出疾病的血清学证据。该病例丰富了孕期抗 NMDA 受体脑炎的稀少文献，并增加了孕期新发精神症状的鉴别诊断。
