Department of neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou City, 450052, Henan Province, China.
BMC Neurol. 2020 Sep 7;20(1):336. doi: 10.1186/s12883-020-01918-7.
N-methyl-D-aspartate receptor (NMDAR) and leucine-rich glioma-inactivated 1 (LGI1) antibodies define the most prevalently recognized autoimmune encephalitis syndromes, while the simultaneous occurrence of both conditions has hardly been published before.
We report the case of a 67-year-old patient who presented with generalized tonic-clonic seizures (GTCS) followed by behavioral changes, psychosis, sleep disorders, decreased consciousness, and faciobrachial dystonic seizures. Ancillary findings included serum hyponatremia and imaging evidence of high-intensity lesions within bilateral medial temporal lobes on T2-weighted fluid attenuation inversion recovery. Both LGI1 and NMDAR antibodies were positive in serum and cerebral spinal fluid using transfected cell based assays. Despite prominent clinical features of anti-LGI1 limbic encephalitis (LGI1-LE), the patient also exhibited overlapping symptoms of anti-NMDAR encephalitis, like early-onset GTCS, which might be related to the concomitant positive NMDAR antibodies.
We report a rare case of LGI1-LE with overlapping symptoms and simultaneous positive NMDAR antibodies. It is necessary to evaluate the presence of NMDAR antibodies in certain LGI1-LE patients with unusual symptoms. However, caution should be exercised in interpreting the observation, given the fact of a single-case study.
N-甲基-D-天冬氨酸受体（NMDAR）和富含亮氨酸胶质瘤失活 1 型（LGI1）抗体定义了最常见的自身免疫性脑炎综合征，而同时发生这两种情况的情况几乎没有报道过。
我们报告了一例 67 岁患者的病例，该患者出现全身强直阵挛性发作（GTCS），随后出现行为改变、精神病、睡眠障碍、意识下降和面臂肌张力障碍性发作。辅助检查包括血清低钠血症和双侧内侧颞叶 T2 加权液体衰减反转恢复高信号病变的影像学证据。使用转染细胞基础检测，血清和脑脊液中均检测到 LGI1 和 NMDAR 抗体阳性。尽管该患者具有明显的抗 LGI1 边缘性脑炎（LGI1-LE）的临床特征，但也表现出重叠的抗 NMDAR 脑炎症状，如早发性 GTCS，这可能与同时存在的阳性 NMDAR 抗体有关。
我们报告了一例罕见的 LGI1-LE 合并重叠症状和同时存在阳性 NMDAR 抗体的病例。在某些具有不典型症状的 LGI1-LE 患者中，有必要评估 NMDAR 抗体的存在。然而，鉴于这是一个单一病例研究，在解释观察结果时应谨慎。
