Pavǎl Denis, Cîmpan Claudia Mihaela, Gherghel Nicoleta, Damian Laura Otilia, Tohǎnean Nicoleta, Micluţia Ioana Valentina
Department of Psychiatry, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Psychiatry Clinic, Emergency County Hospital, Cluj-Napoca, Romania.
Front Psychiatry. 2022 Jun 2;13:905088. doi: 10.3389/fpsyt.2022.905088. eCollection 2022.
The majority of patients with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis present with psychiatric symptoms and subsequently develop neurological features. However, isolated psychiatric episodes occur in <5% of affected individuals, less frequent at disease onset (<1%) compared to relapse (4%). We report the case of a previously healthy 24-year-old female who presented with psychotic symptoms and behavioral alterations. Despite therapy, she showed no improvement and subsequently developed catatonic features. While the ancillary tests were normal, the clinical warning signs raised the suspicion of anti-NMDAR encephalitis which we later confirmed. Given its strong association with underlying tumors, we screened the patient and found an ovarian teratoma. Once removed, the patient displayed a substantial improvement in the mental status. Besides being extremely rare, this case illustrates the need to maintain clinical suspicion of anti-NMDAR encephalitis even in the absence of neurological features or paraclinical anomalies.
大多数抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者最初表现为精神症状，随后出现神经功能特征。然而，孤立的精神发作在<5%的受累个体中出现，与复发时（4%）相比，在疾病发作时（<1%）较少见。我们报告了一例既往健康的24岁女性病例，该患者出现精神病症状和行为改变。尽管接受了治疗，但她并无改善，随后出现了紧张症特征。虽然辅助检查正常，但临床警示信号引发了对抗NMDAR脑炎的怀疑，后来我们证实了这一诊断。鉴于其与潜在肿瘤的密切关联，我们对患者进行了筛查，发现了一个卵巢畸胎瘤。肿瘤切除后，患者的精神状态有了显著改善。除了极为罕见之外，该病例还表明，即使没有神经功能特征或辅助检查异常，也需要对反NMDAR脑炎保持临床怀疑。
