Department of Neurology, Graduate School of Medicine, Chiba University, Japan.
Department of Neurology, Eastern Chiba Medical Center, Japan.
Intern Med. 2021 May 1;60(9):1463-1468. doi: 10.2169/internalmedicine.6344-20. Epub 2020 Nov 23.
We herein report a case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis concurrent with NH-terminal of α-enolase (NAE) antibodies. A 36-year-old Japanese woman presented with Gerstmann's syndrome followed by jerky involuntary movements, seizure, autonomic instability, and consciousness disturbance. NAE antibodies were detected in the serum; however, NMDAR antibodies were identified in the cerebrospinal fluid with a cell-based assay, confirming the diagnosis of anti-NMDAR encephalitis. This case highlights the fact that Gerstmann's syndrome can be a manifestation of anti-NMDAR encephalitis and that NAE may be identified concurrently with NMDAR antibodies, suggesting that the diagnosis of Hashimoto encephalopathy requires the reasonable exclusion of alternative diagnoses, including anti-NMDAR encephalitis.
我们在此报告一例抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎合并 N-末端α-烯醇化酶（NAE）抗体阳性病例。一名 36 岁日本女性以格斯特曼综合征起病，随后出现不自主肌阵挛、癫痫、自主神经不稳定和意识障碍。血清中检测到 NAE 抗体；然而，通过细胞检测在脑脊液中发现了 NMDAR 抗体，从而确诊为抗 NMDAR 脑炎。本病例强调了格斯特曼综合征可能是抗 NMDAR 脑炎的一种表现形式，并且 NAE 可能与 NMDAR 抗体同时出现，提示桥本脑病的诊断需要合理排除其他诊断，包括抗 NMDAR 脑炎。
