Eppinga Hester, Smook Simone P, Jiawan C R, Bosma Ingeborg, van Zelst Willeke H
Universitair Medisch Centrum Groningen, Afd. Psychiatrie, Groningen.
Contactpersoon: H. Eppinga (
Ned Tijdschr Geneeskd. 2019 Dec 5;163:D4024.
Anti-NMDA-receptor-encephalitis is a progressive autoimmune disease with significant mortality if left untreated.
A 58-year-old man without previous psychiatric or neurologic history presented at the emergency department after brief loss of consciousness at work. Within a few hours, the patient developed acute neuropsychiatric symptoms, including altered levels of consciousness, aggression, incoherence, change in behaviour, and psychomotor agitation. Initially, additional blood, cerebrospinal fluid and EEG tests showed no abnormalities. Over the course of the following days, catatonia, orofacial dyskinesia and autonomic-function disorder developed, eventually with respiratory insufficiency, necessitating transfer to the intensive-care unit. At this stage, the EEG did show abnormalities, and cerebrospinal fluid analysis showed marginal pleocytosis. The patient was treated with intravenous methylprednisolone and immunoglobins. Anti-NMDA-receptor antibodies were present in the blood and cerebrospinal fluid. Screening for malignancy identified small-cell lung carcinoma, for which the patient was treated with cytostatic agents.
Acute neuropsychiatric symptoms in a middle-aged patient with no psychiatric medical history are suggestive of an underlying somatic cause. Timely recognition and treatment of anti-NMDA-receptor encephalitis is essential to improve the prognosis.
抗N-甲基-D-天冬氨酸受体脑炎是一种进行性自身免疫性疾病，若不治疗，死亡率很高。
一名58岁男性，既往无精神病史或神经病史，在工作中短暂意识丧失后就诊于急诊科。数小时内，患者出现急性神经精神症状，包括意识水平改变、攻击性、语无伦次、行为改变和精神运动性激越。最初，额外的血液、脑脊液和脑电图检查均未发现异常。在接下来的几天里，出现了紧张症、口面部运动障碍和自主神经功能障碍，最终出现呼吸功能不全，需要转入重症监护病房。在此阶段，脑电图确实显示异常，脑脊液分析显示轻度淋巴细胞增多。患者接受了静脉注射甲泼尼龙和免疫球蛋白治疗。血液和脑脊液中存在抗N-甲基-D-天冬氨酸受体抗体。恶性肿瘤筛查发现了小细胞肺癌，患者接受了细胞毒性药物治疗。
一名无精神病史的中年患者出现急性神经精神症状提示存在潜在的躯体病因。及时识别和治疗抗N-甲基-D-天冬氨酸受体脑炎对于改善预后至关重要。
