儿童抗N-甲基-D-天门冬氨酸受体脑炎的诊断与鉴别诊断

王华

doi:10.7499/j.issn.1008-8830.2014.06.004

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中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (6) : 578-583. DOI: 10.7499/j.issn.1008-8830.2014.06.004

抗NMDAR脑炎专题

儿童抗N-甲基-D-天门冬氨酸受体脑炎的诊断与鉴别诊断

王华

作者信息 +

Diagnosis and differential diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in children

WANG Hua

Author information +

Division of Pediatric Neurology, Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang 110004, China

Aboat authors:

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[3] Suh-Lailam BB, Haven TR, Copple SS, et al. Anti-NMDAreceptorantibody encephalitis: performance evaluation and laboratory experance with the anti-NMDA-receptor IgG assay[J].Clin Chim Acta, 2013, 421: 1-6.
[4] Thomas L, Mailles A, Desestret V, et al. Autoimmune N-methyl- D-aspartate receptor encephalitis is a differential diagnosis of infectious encephalitis[J].J Infect, 2014, 68(5): 419-425.
[5] Shiho Takano S, Takahashi T, Kishi H, et al. Detection of autoantibody against extracellular epitopes of N-methyl-D-aspartate receptor by cell-based assay[J].Neurosci Res, 2011, 71(2): 294- 302.
[6] Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series andanalysis of the effects of antibodys[J].Lancet Neurol, 2008, 7(12): 1091-1098.
[7] Miya K, Takahashi Y, Mori H. Anti-NMDAR autoimmune encephalitis[J].Brain Dev, 2013 doi: 10.1016/j.braindev. 2013.10.005. [Epub ahead of print].
[8] Armangue T, Titulaer MJ, Málaga I, et al. Pediatric anti-N-methyl- D-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients[J].J Pediatr, 2013, 162(4): 850- 856.
[9] Malter MP, Elger CE, Surges R. Diagnostic value of CSF fidings in antibody-associated limbic and anti-NMDAR-encephalitis[J].Seizure, 2013, 22(1): 136-140.
[10] Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: A unique EEG pattern in adults with anti-NMDA receptor encephalitis[J].Neurology, 2012, 79(11): 1094-1100.
[11] Leypoldt F, Buchert R, Kleiter I, et al. Fluorodeoxyglucose positron emission tomography in anti-NMDA receptor encephalitis: distinct pattern of disease[J].J Neurol Neurosurg Psychitr, 2012, 83(7): 681-686.
[12] Dalmau J, Tuzun E, Wu HY, et al. Paraneoplastic anti-Nmethyl- D-aspartate receptoe encephalitis associated with ovarian teretoma[J].Ann neurology, 2007, 61(1): 25-36.
[13] Yau ML, Fung EL. Early consideration of anti-NMDAR encephalitis in unexplained encephalopathy[J].Hong Kong Med J, 2013, 19(4): 362-364.

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文章历史 +

摘要

自身免疫性脑炎相对少见，且临床表现多种多样，很难在疾病早期给予确诊。因此，儿科临床医生应该熟悉自身免疫性脑炎的临床症状、体征、辅助检查特点、影像学改变、免疫学特征以及鉴别诊断要点。为正确诊断抗N-甲基-D-天门冬氨酸受体（NMDAR）脑炎，患儿应该进行包括寡克隆带检测的脑脊液检查、头颅磁共振扫描以及普通脑电图和/ 或24 h 视频脑电图检查。对于早期出现精神症状和癫癎发作的患儿尤其注意进行血液和脑脊液中抗NMDAR 抗体测定。脑电图出现“δ 刷”时对该病临床诊断有帮助。脑脊液NMDAR 抗体阳性是诊断该病的金标准。抗NMDAR 脑炎的鉴别诊断非常宽泛，儿童患者应该主要与单纯疱疹病毒性脑炎、其他自身免疫性脑炎及精神病相鉴别。

Abstract

Autoimmune encephalitis is rare and has various clinical manifestations, which may hamper the correct diagnosis. Therefore, the pediatrician should be familiar with the clinical symptoms, signs, laboratory features, neuroimaging changes, immunological characteristics, and differential diagnosis of this disease. In order to correctly diagnose anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, cerebrospinal fluid (CSF) examinations including detection of oligoclonal bands, brain MRI scanning, and routine EEG and/or 24 hours video EEG should be performed in children. For highly suspected cases, particularly children presenting with psychiatric symptoms and epileptic seizures, examinations should be done to detect anti-NMDAR antibodies (Abs) in serum and CSF. A notable feature in children is the EEG pattern named "extreme delta brush", which may help confirm the clinical diagnosis. Anti-NMDAR Abs in CSF is the diagnostic "gold-standard" for this disease. The differential diagnosis of anti-NMDAR encephalitis is broad. In pediatric patients, the differential diagnosis should be made mainly with herpes simplex virus encephalitis, other autoimmune encephalitis, and psychosis.

导出引用

王华. 儿童抗N-甲基-D-天门冬氨酸受体脑炎的诊断与鉴别诊断[J]. 中国当代儿科杂志. 2014, 16(6): 578-583 https://doi.org/10.7499/j.issn.1008-8830.2014.06.004

WANG Hua. Diagnosis and differential diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in children[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(6): 578-583 https://doi.org/10.7499/j.issn.1008-8830.2014.06.004