视神经炎缓解期发生抗NMDAR脑炎1例并文献复习

doi:10.3969/j.issn.1004-583X.2025.05.012

摘要/Abstract

摘要：

目的探讨视神经炎缓解期发生抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate-receptor, NMDAR)脑炎的临床特征。方法回顾性分析视神经炎缓解期出现抗NMDAR脑炎患者1例,并结合已发表的国内外文献进行复习。结果患者28岁女性,因“发作性意识不清、四肢抽搐伴幻听2 h 40 min”就诊,既往视神经炎激素冲击治疗减量过程中出现“癫痫样发作”,住院期间再次癫痫发作。行头颅磁共振成像示边缘叶脑炎并脑膜炎;血清、脑脊液检查抗NMDAR1抗体阳性。诊断为“视神经炎缓解期抗NMDAR脑炎”,经激素治疗后症状好转,1年后随访未见复发。结论视神经炎患者出现癫痫症状时,建议行自身免疫性脑炎相关抗体检测,尽早明确诊断及治疗。

关键词: 抗N-甲基-D-门冬氨酸受体脑炎, 视神经炎, AQP4抗体阴性, MOG抗体阴性

Abstract:

Objective To investigate the clinical characteristics of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis during the remission of optic neuritis. Methods A case of anti-NMDAR encephalitis during the remission of optic neuritis was retrospectively analyzed, and the published literatures at home and abroad were reviewed. Results A 28-year-old female presented with episodic unconsciousness, convulsions of the limbs and auditory hallucinations for 2 hours and 40 minutes. Epilepsy seizures occurred again during the hospitalization period. The patient had a history of epileptic seizures during the dosage reduction of hormone shock therapy for optic neuritis. Cranial magnetic resonance imaging showed marginal lobe encephalitis and meningitis. Serum and cerebrospinal fluid tests were positive for the anti-NMDAR1 antibody. The patient was then diagnosed with anti-NMDAR encephalitis during the remission of optic neuritis. Hormone treatment effectively relieved the symptoms, without recurrence at 1 year of follow-up. Conclusion Epilepsy symptoms in patients with optic neuritis alert testing for antibodies associated with autoimmune encephalitis. An early diagnosis favors the treatment.

Key words: anti-N-methyl-D-aspartate receptor encephalitis, optic neuritis, negative AQP4 antibody, negative MOG antibody

中图分类号:

R739.4
R745

孔凡丛, 王方玉, 范楷, 刘耿熙, 赵连江, 刘菲. 视神经炎缓解期发生抗NMDAR脑炎1例并文献复习[J]. 临床荟萃, 2025, 40(5): 450-453.

Kong Fancong, Wang Fangyu, Fan Kai, Liu Gengxi, Zhao Lianjiang, Liu Fei. Anti-NMDAR encephalitis during the remission of optic neuritis: A case report and literature review[J]. Clinical Focus, 2025, 40(5): 450-453.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.05.012

https://lchc.magtechjournal.com/CN/Y2025/V40/I5/450

图/表 2

参考文献 19

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项目	脑脊液结果	血清结果	参考区间
抗NMDAR1抗体IgG	强阳性(+++)	弱阳性(+)	阴性(-)
抗AMPA1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗AMPA2抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗LGI1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GABABR1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗CASPR2抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗DPPX(全)抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗DPPX(外膜)抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗IgLON5抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗AQP4抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗MOG抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GQ1b抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GQ1b抗体IgM	阴性(-)	阴性(-)	阴性(-)

项目	脑脊液结果	血清结果	参考区间
抗NMDAR1抗体IgG	强阳性(+++)	弱阳性(+)	阴性(-)
抗AMPA1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗AMPA2抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗LGI1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GABABR1抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗CASPR2抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗DPPX(全)抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗DPPX(外膜)抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗IgLON5抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗AQP4抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗MOG抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GQ1b抗体IgG	阴性(-)	阴性(-)	阴性(-)
抗GQ1b抗体IgM	阴性(-)	阴性(-)	阴性(-)