重症抗NMDAR脑炎临床、影像学及脑电图特征研究

目的分析重症抗NMDAR脑炎临床,影像学及脑电图(EEG)特征。方法 23例血清和/或脑脊液(CSF)抗NMDAR抗体阳性、MRS评分4-5分的重症抗NMDAR脑炎,分析CSF白细胞数、意识障碍严重程度、呼吸功能衰竭特点及头颅MRI、24h长程视频脑电图(VEEG)特点。结果 23例重症抗NMDAR脑炎中,精神行为异常19例(82.6%),意识障碍20例(87%)。CSF白细胞数增高19例(82.6%),与轻症抗NMDAR脑炎差异无统计学意义(P0.05)。癫痫发作17例(73.9%),其中癫痫持续状态13例(56.5%)。24h VEEG监测,广泛慢波15例,其中θ波为主调12例,δ波为主调3例。14~20HZ快波背景2例,额顶枕颞导棘波、尖波或尖慢综合波发放6例,未见异常1例。头颅MRI异常14例(60.9%),其中累及额、颞、顶枕叶皮质6例,皮质下白质多发异常信号5例,累及海马5例,累及脑干2例,未见异常9例。呼吸功能衰竭10例(43.5%),Ⅰ型呼吸功能衰竭6例,Ⅱ型呼吸功能衰竭4例。结论重症抗NMDAR脑炎疾病的严重程度、CSF白细胞数量、意识障碍程度与抗NMDAR抗体的滴度无关,重症抗NMDAR脑炎易出现癫痫持续状态和中枢性通气不足所致呼吸功能衰竭。

Severity anti-N-methyl-D-aspartate receptor encephalitis:review of clinical presentation,imaging and electroencephalogram

Objective To analysis the clinical presentation,imaging and electroencephalogram of severity anti NMDA receptor encephalitis.Method Twenty three patients were confirmed to have serum or cerebrospinal fluid (CSF) antibodies to the NMDA receptor,Modified Rankin Scale(MRS) were 4-5 scores.To analysis the charactor of white blood cells in CSF,severity of disturbance of consciousness,failure of respiration, head MRI and 24 hour long-term video electroencephalogram(VEEG).Results In the twenty three patients with severity anti NMDA receptor encephalitis,nineteen patients showed psychiatric disorder(82.6%),twenty patients showed disturbance of consciousness(87%).White blood cells in CSF of severe anti NMDA receptor encephalitis had no different with that of in mild anti NMDA receptor encephalitis(P<0.05). Seventeen cases of seizure(73.9%)including thirteen cases of status epileptics(56.5%).By 24hVEEG ,fifteen patients showed wide slow wave including twelve cases of θ wave ,five cases of δ wave. Two patients showed 10-20 HZ fast wave background.Six patients showed spike wave,sharp wave,spike slow wave.Only one case was normal VEEG.Fourteen patients were abnormal signals in MRI including six cases of cortex of frontal , temporal,parietal and occipital, five cases of subcortical white matter,five cases of hippocampus,two cases of brain stem, MRI showed normal in 9 cases. In ten cases with respiratory failure (43.5%), six cases were type I and four cases were type Ⅱ respiratory failure.Conclusion Severity ,white blood cells in CSF and degree of disturbance of consciousness has nothing to do with the titer of anti NMDA receptor antibody ,the status of epilepsy is easy to occur and the respiratory failure caused by central ventilation is insufficient in severity anti NMDA receptor encephalitis.