江汉大学学报(自然科学版) ›› 2021, Vol. 49 ›› Issue (3): 91-96.doi: 10.16389/j.cnki.cn42-1737/n.2021.03.013

• 医学 • 上一篇    

1 例抗N-甲基-D-天冬氨酸受体脑炎合并失眠的病例报道并文献复习

尤红1,陈国华*2   

  1. 1. 江汉大学 医学院,湖北 武汉 430056;2. 武汉市第一医院 神经内科,湖北 武汉 430022
  • 发布日期:2021-05-18
  • 通讯作者: 陈国华
  • 作者简介:尤红(1995— ),女,硕士生,研究方向:神经病学。

Anti-NMDAR Encephalitis with Insomnia:A Case Report and Literature Review

YOU Hong1,CHEN Guohua*2   

  1. 1. School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;2. Department of Neurology,Wuhan No.1 Hospital,Wuhan 430022,Hubei,China
  • Published:2021-05-18
  • Contact: CHEN Guohua

摘要: 目 的 探讨抗N- 甲基-D- 天冬氨酸受体脑炎(抗NMDAR 脑炎)的临床表现以及诊治方法。方 法 报道1 例抗NMDAR 脑炎患者的临床表现、影像学、脑脊液、多导睡眠监测(PSG)、诊断及治疗方法,并结合文献进行复习。结 果 患者有失眠、视物模糊、发热、感觉异常、反应迟钝等临床表现,脑脊液检测出抗N-甲基-D-天冬氨酸受体脑炎抗体IgG,符合抗NMDAR 脑炎的诊断标准。使用激素联合免疫球蛋白治疗取得良好效果。结 论 抗NMDAR 脑炎临床症状不典型时容易漏诊,即使颅脑磁共振未发现异常,也应积极行脑脊液自身免疫性脑炎谱检测,早期确诊后行激素联合免疫球蛋白治疗,改善患者预后,并进行长期追踪随访。

关键词: 抗NMDAR 脑炎, 失眠, 脑脊液, 多导睡眠监测(PSG)

Abstract: Objective To investigate the clinical manifestation,diagnosis and treatment of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis). Methods The clinical manifestations, imaging, cerebrospinal fluid, polysomnography (PSG),diagnosis and treatment of 1 case of Anti-NMDAR encephalitis were reported, combined with the literature review. Results The patient had clinical manifestations such as insomnia, blurred vision, fever, abnormal sensation, and slow response, and anti-NMDAR encephalitis antibody IgG was detected in the cerebrospinal fluid,which met the diagnostic criteria of anti-NMDAR encephalitis. The patient with hormone combined with immunoglobulin treatment achieved good results. Conclusion When the clinical symptoms of anti-NMDAR encephalitis are atypical,it is easy to miss the diagnosis. Even if no abnormality is found in the brain MRI,autoimmune encephalitis detection of the cerebrospinal fluid should be detected actively. The treatment of hormone with immunoglobulin should be performed after the early diagnosis to improve the prognosis of the patient,and long-term follow-up should be carried out.

Key words: anti-NMDAR encephalitis, insomnia, cerebrospinal fluid, polysomnography(PSG)

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