CAJ | 학술논문

目的分析我国成年人抗N-甲基-D-天冬氨酸(NMDA)受体脑炎患者的临床、头MRI和脑脊液特点.方法收集29例抗NMDA受体脑炎患者的临床、MRI和脑脊液资料.结果 29例抗NMDA受体脑炎中,主要临床表现为精神异常占86％(25例),癫痫83％(24例),意识障碍55％(16例),不自主运动55％(16例),中枢性通气障碍34％(10例),大量唾液分泌17％(5例),尚有自主神经紊乱、偏瘫、失语等.14％(4例)伴有畸胎瘤.头MRI异常者占62％(18例),病灶分布于颞叶、海马、丘脑、脑干、扣带回、额顶叶、胼胝体、内囊/基底节/脑室旁.83％腰椎穿刺结果异常,其中脑脊液寡克隆区带阳性率为95％ (19/20).3年内复发率为31％ (9/29).结论抗NMDA受体脑炎患者主要临床表现为精神异常、癫痫,特征性临床表现有不自主运动、中枢性通气障碍、大量唾液分泌;MRI病灶分布不仅局限于边缘叶;是复发率较高但可治疗的疾病.
목적 분석아국성년인항N-갑기-D-천동안산(NMDA)수체뇌염환자적림상、두MRI화뇌척액특점.방법 수집29례항NMDA수체뇌염환자적림상、MRI화뇌척액자료.결과 29례항NMDA수체뇌염중,주요림상표현위정신이상점86％(25례),전간83％(24례),의식장애55％(16례),불자주운동55％(16례),중추성통기장애34％(10례),대량타액분비17％(5례),상유자주신경문란、편탄、실어등.14％(4례)반유기태류.두MRI이상자점62％(18례),병조분포우섭협、해마、구뇌、뇌간、구대회、액정협、변지체、내낭/기저절/뇌실방.83％요추천자결과이상,기중뇌척액과극륭구대양성솔위95％ (19/20).3년내복발솔위31％ (9/29).결론 항NMDA수체뇌염환자주요림상표현위정신이상、전간,특정성림상표현유불자주운동、중추성통기장애、대량타액분비;MRI병조분포불부국한우변연협;시복발솔교고단가치료적질병.
Objective To analyze the clinical manifestations and the features of brain MRI and cerebrospinal fluid (CSF) findings in adult Chinese patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods We reviewed the clinical manifestations,brain MRI and CSF examinations of 29 patients who were diagnosed as anti-NMDAR encephalitis.Results The major clinical features of anti-NMDAR encephalitis patients included psychiatric symptoms (86％,25/29),seizures (83％,24/29),decreased consciousness (55％,16/29),involuntary movements (55％,16/29),central hypoventilation (34％,10/29),and hypersalivation (17％,5/29).Some patients also experienced autonomic instability,hemiplegia and aphasia.Underlying ovarian teratoma was identified in 14％ of affected patients(4/29).Brain MRI was found abnormal in up to 62％ patients (18/29),located in the temporal lobes,hippocampus,thalamus,brain stem,cingulate gyrus,frontal and parietal cortex,corpus callosum,internal capsule,basal ganglia and periventricular area.CSF findings were abnormal in 83％ of patients with anti-NMDAR encephalitis.Oligoclonal banding in CSF was positive in 95％ patients (19/20).The recurrence rate during 3 years was 31％ (9/29).Conclusions Anti-NMDAR encephalitis is a treatable disease,yet with high recurrence rate.Its predominant clinical features are psychiatric symptoms and seizures,while involuntary movements,central hypoventilation and hypersalivation are its characteristic manifestations.Lesions in MRI are widespread,not only restricted to limbic lobe.