Luo Yuanyuan, Li Jieying, Jiang Fugui, Tan Arui, Qin Xiaohong, Xiao Xiaoqiang, Wang Zuxing, Wang Peijia, Yi Yang, Li Juan, Yuan Shuai, Liu Lei, Xiao Jun
Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.
Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China.
Front Psychiatry. 2022 Feb 14;13:827138. doi: 10.3389/fpsyt.2022.827138. eCollection 2022.
Autoimmune encephalitis is characterized by mental and behavioral symptoms, seizures, and cognitive impairment. The presence of schizophrenia needs to be distinguished from that of autoimmune encephalitis. Herein, we describe the case of a woman who exhibited abnormal mental behavior and cognitive impairment. The patient had experienced similar symptoms more than 20 years previously and had been diagnosed with schizophrenia. The patient's psychotic symptoms improved after treatment with antipsychotic drugs; however, cognitive impairment persisted. She was diagnosed with anti-N-methyl-D-aspartate (NMDA)-receptor concurrent with anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-receptor encephalitis. She showed improvement after treatment with steroids and intravenous immunoglobulins (IVIgs). Furthermore, we reviewed the literature and found that, including the present case, 10 patients have been diagnosed with anti-NMDA concurrent with anti-AMPA-receptor encephalitis. Three of these patients were men and seven were women, and their ages ranged from 21 to 71 years. Moreover, seven (70%) patients had a history of tumors. Symptoms of these patients included psychotic symptoms, varying degrees of consciousness disturbance, seizures, dyskinesia, dystonia, autonomic dysfunction, agitation, and verbal reduction. Brain magnetic resonance imaging findings showed scattered fluid-attenuated inversion recovery hyperintensity in subcortical white matter and/or medial temporal lobe in seven (70%) patients. After combination treatment, including tumor removal and administration of steroids, IVIg, plasma exchange, or immunity inhibitors, the symptoms improved in part of the patients. It is necessary to exclude autoimmune encephalitis for patients with psychiatric manifestations and cognitive impairment. Timely combination therapy is important in anti-NMDA-receptor concurrent with anti-AMPA-receptor encephalitis.
自身免疫性脑炎的特征为精神和行为症状、癫痫发作及认知障碍。需要将精神分裂症与自身免疫性脑炎相鉴别。在此，我们描述一例出现异常精神行为和认知障碍的女性病例。该患者20多年前曾出现过类似症状，当时被诊断为精神分裂症。经抗精神病药物治疗后，患者的精神病性症状有所改善；然而，认知障碍依然存在。她被诊断为抗N-甲基-D-天冬氨酸（NMDA）受体合并抗α-氨基-3-羟基-5-甲基-4-异恶唑丙酸（AMPA）受体脑炎。经类固醇和静脉注射免疫球蛋白（IVIg）治疗后，她的症状有所改善。此外，我们查阅文献发现，包括本病例在内，已有10例患者被诊断为抗NMDA受体合并抗AMPA受体脑炎。其中3例为男性，7例为女性，年龄在21岁至71岁之间。而且，7例（70%）患者有肿瘤病史。这些患者的症状包括精神病性症状、不同程度的意识障碍、癫痫发作、运动障碍、肌张力障碍、自主神经功能障碍、激越及言语减少。脑部磁共振成像结果显示，7例（70%）患者的皮质下白质和/或颞叶内侧有散在的液体衰减反转恢复高信号。经过包括肿瘤切除及给予类固醇、IVIg、血浆置换或免疫抑制剂在内的联合治疗后，部分患者的症状有所改善。对于有精神症状和认知障碍的患者，有必要排除自身免疫性脑炎。在抗NMDA受体合并抗AMPA受体脑炎中，及时进行联合治疗很重要。
