N-甲基-D-天冬氨酸受体脑炎中口面部运动障碍的孤立夜间发作——一个新的诊断线索
Isolated Nocturnal Occurrence of Orofacial Dyskinesias in N-methyl-D-aspartate Receptor Encephalitis-A New Diagnostic Clue.
作者信息
Morales-Briceño Hugo, Fung Victor S C
机构信息
Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.
Sydney Medical School The University of Sydney Sydney New South Wales Australia.
出版信息
Mov Disord Clin Pract. 2017 Sep 26;4(6):884-886. doi: 10.1002/mdc3.12535. eCollection 2017 Nov-Dec.
BACKGROUND
The syndrome of anti--methyl-D-aspartate receptor encephalitis is classically associated with a combination of limbic dysfunction, dysautonomia, central hypoventilation and movement disorders. On clinical grounds, the diagnosis is often supported by the presence of generalized dyskinesias in a patient with encephalopathy and catatonic signs. Orofacial dyskinesias have been recognized as characteristic of the disorder but can be absent in some patients. Pure psychiatric syndromes without movement disorders have also been described.
METHODS AND RESULTS
The authors describe 2 male patients who presented with prominent neuropsychiatric symptoms without movement disorders during wakefulness but isolated orofacial dyskinesias during sleep. In 1 patient, this observation supported the early introduction of immunotherapy; and, in both patients, the clinical outcome was excellent.
CONCLUSIONS
Careful history and nocturnal examination may reveal orofacial dyskinesias in patients with -methyl-D-aspartate receptor encephalitis who have apparent pure psychiatric manifestations.
背景
抗N-甲基-D-天冬氨酸受体脑炎综合征典型地与边缘系统功能障碍、自主神经功能障碍、中枢性通气不足及运动障碍相关。基于临床情况，脑病和紧张症体征患者出现全身性运动障碍常支持该诊断。口面部运动障碍已被认为是该疾病的特征，但部分患者可能无此表现。也有关于无运动障碍的单纯精神综合征的描述。
方法与结果
作者描述了2例男性患者，他们在清醒时表现为突出的神经精神症状且无运动障碍，但在睡眠中出现孤立的口面部运动障碍。在1例患者中，这一观察结果支持早期引入免疫治疗；且2例患者的临床结局均良好。
结论
对于表现为明显单纯精神症状的抗N-甲基-D-天冬氨酸受体脑炎患者，仔细询问病史及进行夜间检查可能会发现口面部运动障碍。
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