CAJ | 학술논문

目的：加强对抗N-甲基-D-天冬氨酸( N-methyl-D-asparate, NMDA)受体脑炎临床特点的认识,减少临床误诊。方法对我科收治的3例抗NMDA受体脑炎误诊病例资料进行回顾性分析并复习相关文献。结果本组2例以癫痫发作就诊,1例以精神行为异常就诊。2例在疾病初期误诊为病毒性脑炎,1例误诊为脑胶质瘤。入院后因脑脊液病毒学检测阴性或血肿瘤标志物正常,综合分析病情考虑自身免疫性脑炎可能,行脑脊液抗NMDA受体抗体检测阳性,诊断为抗NMDA受体脑炎。给予糖皮质激素和(或)免疫球蛋白治疗,症状控制,生活可自理,但遗留记忆力稍减退和(或)轻度反应迟钝。结论接诊以癫痫或精神行为异常起病,伴有运动异常或自主神经症状者,应考虑抗NMDA受体脑炎可能,及时行血或脑脊液抗NMDA受体抗体检测明确诊断,以免误漏诊。
목적：가강대항N-갑기-D-천동안산( N-methyl-D-asparate, NMDA)수체뇌염림상특점적인식,감소림상오진。방법대아과수치적3례항NMDA수체뇌염오진병례자료진행회고성분석병복습상관문헌。결과본조2례이전간발작취진,1례이정신행위이상취진。2례재질병초기오진위병독성뇌염,1례오진위뇌효질류。입원후인뇌척액병독학검측음성혹혈종류표지물정상,종합분석병정고필자신면역성뇌염가능,행뇌척액항NMDA수체항체검측양성,진단위항NMDA수체뇌염。급여당피질격소화(혹)면역구단백치료,증상공제,생활가자리,단유류기억력초감퇴화(혹)경도반응지둔。결론접진이전간혹정신행위이상기병,반유운동이상혹자주신경증상자,응고필항NMDA수체뇌염가능,급시행혈혹뇌척액항NMDA수체항체검측명학진단,이면오루진。
Objective To improve awareness of N-methyl-D-aspartate receptor encephalitis and prevent misdiagnosis. Methods The misdiagnosis cause was retrospective analyzed for 3 cases in our department and related literature was re-viewed. Results In 3 cases, 2 cases showed seizure and 1 case showed behavioral abnormalities at onset. 2 cases were misdi-agnosed as viral encephalitis and 1 case was misdiagnosed as brain glioma on admission. The virus testing in cerebrospinal flu-id ( CSF) and the serum tumor maker were normal. Autoimmune encephalitis was considered based on different clinical symp-toms. Lumber puncture was performed and anti-NMDAR antibody was positive in CSF. Anti-NMDAR encephalitis was con-firmed. The patients were treated with glucocorticoids and/or immune globulin and recovered with mild memory loss and/or dull reaction. Conclusion Anti-NMDAR encephalitis should be considered if the patients show seizure or psychological symp-toms with movement disorders and autonomic dysfunction. To test anti-NMDAR antibody in CSF and/or in serum is necessary in diagnosis of the disease.