Sabbula Bhanu R, Yemmanur Shravya, Sanivarapu Raghavendra, Kagolanu Deepthi, Shadab Ahmed
Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA.
Division of Infectious Disease, Nassau University Medical Center, East Meadow, NY, USA.
Case Rep Med. 2020 Oct 13;2020:2074704. doi: 10.1155/2020/2074704. eCollection 2020.
An autoimmune response causing inflammation in the brain tissue is called autoimmune encephalitis. Autoantibodies directed against N-methyl-D-aspartate (NMDA) receptors cause a type of autoimmune encephalitis resulting in memory loss, confusion, and psychosis. A 28-year-old male with a history of schizophrenia, seizure disorder, and stroke presented with a 2-day history of bizarre behavior, restlessness, insomnia, agitation, and hallucinations. He was initially managed for acute psychosis without any improvement. Further workup for organic causes revealed positive NMDAR antibodies in both the cerebrospinal fluid and serum, confirming a diagnosis of autoimmune encephalitis. His condition later improved with steroids and intravenous immunoglobulins. This case signifies the importance of ruling out organic causes in patients with unexplained neuropsychiatric symptoms. NMDA encephalitis is more common in young females with underlying malignancies, especially ovarian teratomas. This case is unique, given the extremely rare occurrence of NMDA encephalitis in male patients without any malignancies.
一种导致脑组织炎症的自身免疫反应称为自身免疫性脑炎。针对N-甲基-D-天冬氨酸（NMDA）受体的自身抗体可引发一种自身免疫性脑炎，导致记忆丧失、意识模糊和精神病症状。一名有精神分裂症、癫痫症和中风病史的28岁男性，出现了为期2天的怪异行为、烦躁不安、失眠、激动和幻觉症状。他最初按急性精神病进行治疗，但没有任何改善。对器质性病因的进一步检查发现脑脊液和血清中NMDAR抗体均呈阳性，确诊为自身免疫性脑炎。他的病情后来通过类固醇和静脉注射免疫球蛋白得到了改善。该病例表明，对于有无法解释的神经精神症状的患者，排除器质性病因非常重要。NMDA脑炎在患有潜在恶性肿瘤（尤其是卵巢畸胎瘤）的年轻女性中更为常见。鉴于在没有任何恶性肿瘤的男性患者中极少发生NMDA脑炎，该病例很独特。
