误诊为精神障碍的抗N-甲基-D-天冬氨酸受体脑炎43例分析

目的:探讨误诊为精神障碍的抗N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate-receptor；NMDAR）脑炎患者的临床特征，提高早期诊断率，减少误诊。方法:收集2012年至2018年在郑州大学第一附属医院确诊的抗NMDA受体脑炎患者的临床资料，筛选出误诊为精神障碍疾病的患者，回顾性分析其精神症状特征、病程特点、影像学及实验室检查结果，治疗及预后情况。结果:共收集121例确诊为抗NMDA受体脑炎患者，筛选出误诊为精神障碍的43例。43例患者中，16例（37.2％）存在前驱症状，所有患者均有精神行为异常（100％），其中癫痫发作32例（74.4％）、意识水平下降13例（30.2％）、不自主运动21例（48.8％）、记忆力下降15例（34.9％）、言语功能障碍8例（18.6％）、其他神经系统症状（中枢性低通气、自主神经功能障碍）8例（18.6％），各种不同症状可能在同一患者身上同时或相继出现，症状完全缓解或只留下轻微肢体障碍者38例，遗留精神异常和癫痫发作反复入院者5例，复发率占11.6%（5/43）。结论:抗NMDA受体脑炎临床表现复杂多样，多数以精神行为异常为首发症状，极易误诊为精神障碍，延迟治疗会导致病程延长，预后不良。

Analysis of 43 cases of anti-NMDA receptor encephalitis misdiagnosed as mental disorder

Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.