[1]黄梁江,邓春初,李大勇,等.视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎1例[J].卒中与神经疾病杂志,2017,24(01):18-20.[doi:10.3969/j.issn.1007-0478.2017.01.004]
　Huang Liangjiang,Deng Chunchu,Li Dayong,et al.A case of neuromyelitis optica combined with anti-NMDA receptor encephalitis[J].Stroke and Nervous Diseases,2017,24(01):18-20.[doi:10.3969/j.issn.1007-0478.2017.01.004]
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视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎1例()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第24卷
期数:
2017年01期
页码:
18-20
栏目:
论 著
出版日期:
2017-02-26

文章信息/Info

Title:
A case of neuromyelitis optica combined with anti-NMDA receptor encephalitis
文章编号:
1007-0478(2017)01-0018-03
作者:
黄梁江; 邓春初; 李大勇; 熊永洁; 张苏明; 黄晓江
430030 武汉,华中科技大学同济医学院附属同济医院神经内科[黄梁江 邓春初 李大勇 熊永洁 张苏明(深圳华中科技大学研究院)黄晓江(通信作者)]
Author(s):
Huang Liangjiang; Deng Chunchu; Li Dayong; et al.
Department of Neurology,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030
关键词:
自身免疫性脑炎 N-甲基-D-天冬氨酸受体 水通道蛋白4 视神经脊髓炎 心动过缓
Keywords:
Autoimmune encephalitis N-methyl-D-aspartate receptor Aquaporin-4 Neuromyelitis optica Bradycardia
分类号:
R512.3 R744.5+2
DOI:
10.3969/j.issn.1007-0478.2017.01.004
摘要:
目的 探讨视神经脊髓炎合并抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的临床特征。方法 报道本院收治的1例视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎的临床特点及诊治经过,并结合文献分析该病的特征。结果 患者为21岁女性,表现为腹泻后急性起病的下肢麻木无力、昏睡、视物模糊; MRI示双侧基底节、海马、桥臂、齿状回、延髓背侧多发异常信号,同时伴有颈髓多发条片状长T2异常信号。脑脊液NMDA受体抗体阳性,血清和脑脊液水通道蛋白4(AQP4)抗体阳性,合并心动过缓并发症,筛查未发现肿瘤; 经激素冲击、丙种球蛋白及免疫抑制剂治疗后症状逐渐好转至痊愈。结论 视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎可以在感染后起病,症状和影像学主要表现为两种疾病的叠加,可出现心动过缓并发症,早期积极行免疫治疗效果较好。
Abstract:
ObjectiveTo explore the clinical characteristics of neuromyelitis optica combined with anti-N-methyl-D-aspartate( NMDA)receptor encephalitis.Methods A case of neuromyelitis optica combined with anti-NMDA receptor encephalitis was reported,and the diagnosis and treatment were analyzed.The related literatures of this disease were reviewed.Results A 21-year-old woman suffered from sudden lower limb numbness and weakness,lethargy and blurred vision after diarrhea.MRI revealed multiple abnormal signals in bilateral basal ganglias,hippocampus,pontine arm,dentate gyrus and dorsalis medulla oblongata.Many abnormal long T2 signals were found in cervical cord.The antibody of NMDA receptor was positive in cerebrospinal fluid,and aquaporin-4 antibody was also positive in blood and cerebrospinal fluid.Bradycardia was also found in this patient without tumors.Impulsive therapy with steroid and immunotherapy with gammaglobulin achieved a good clinical outcome.Conclusion Neuromyelitis optica combined with anti-NMDA receptor encephalitis can occur after intestinal infection,and the symptoms and imaging characteristics are presented with the two clinical syndromes of neuromyelitis optica and anti-NMDA encephalitis.Bradycardia can also occur in this disease,and timely immunotherapy is effective.

参考文献/References:

[1] Dalmau J,Tuzun E,Wu HY,et al.Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma[J].Ann Neurol,2007,61(1):25-36.
[2] 任海涛,杨洵哲,关鸿志,等.多重抗神经元抗体阳性的自身免疫性脑炎临床分析[J].中华神经科杂志,2016,49(1):21-25.
[3] 许春伶,赵伟秦,李继梅,等.抗N-甲基-D-天冬氨酸受体脑炎一例[J].中华神经科杂志,2010,43(11):781-783.
[4] Drori T CJ,Classification of Neuromyelitis Optica.Devic's syndrome[J].Autoimmun Rev,2014,13(4/5):531-533.
[5] Titulaer MJ,H ftberger R,Iizuka T,et al.Overlapping demyelinating syndromes and anti N-methyl-D-aspartate receptor encephalitis[J].Ann Neurol,2014,75(3):411-428.
[6] Berger B,Pytlik M,Hottenrott T,et al.Absent anti-N-methyl-D-aspartate receptor NR1a antibodies in herpes simplex virus encephalitis and varicella zoster virus infections[J].Int J Neurosci,2017,172(2):109-117.
[7] Kampylafka EI,Alexopoulos H,El Hamidieh A,et al.Immunization of mice with a peptide derived from the HTLV-1 TAX1BP1 protein induces cross-reactive antibodies against aquaporin 4[J].Autoimmunity,2015,48(7):1-7.
[8] Boronat A,Sabater L,Saiz A,et al.GABA(B)receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders[J].Neurology,2011,76(9):795-800.
[9] Naasan G,Irani SR,Bettcher BM,et al.Episodic bradycardia as neurocardiac prodrome to voltage-gated Potassium Channel complex/leucine-rich,glioma inactivated 1 antibody encephalitis[J].JAMA Neurol,2014,71(10):1300-1304.
[10] Dalmau J,Lancaster E,Martinez-Hernandez E,et al.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis[J].The Lancet Neurology,2011,10(1):63-74.
[11] Fleischmann R,Prüss H,Rosche B,et al.Severe cognitive impairment associated with intrathecal antibodies to the NR1 subunit of the N-methyl-D-aspartate receptor in a patient with multiple sclerosis[J].JAMA Neurol,2015,72(1):96-99.
[12] Waschbisch A,Kallmünzer B,Schwab S,et al.Demyelinating disease and anti-N-methyl-D-aspartate receptor immunoglobulin G antibodies:a case report[J].BMC Res Notes,2014,7:948.

备注/Memo

备注/Memo:
基金项目:深圳市科技计划项目(JCYJ2014050916270497)
更新日期/Last Update: 2017-02-20