Anti-N-methyl-D-aspartate receptor encephalitis: analysis of three cases

Abstract

Objective To explore the clinical features, diagnosis, treatment and prognosis of patients with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. Methods and Results Three patients had psychiatric symptoms, intractable epilepsy, disturbance of consciousness and hypoventilation. Two patients had fever. Two patients had autonomic dysfunction (one presented diaphoresis, hypersalivation and sinus arrhythmia, the other one presented nodal tachycardia) and orofacial-limb dyskinesia. All cases were detectied anti-NMDA receptor antibodies positive in serum and cerebrospinal fluid (CSF). CSF white blood cell count and protein quantification presented as non-specific inflammatory changes. Tumor markers screening were negative, and the results of head MRI were abnormal, but not specific. EEG manifestation was non-specific abnormal in 2 patients, while the other one did not undergo EEG inspection. Two patients had clinical symptom improvement after receiving immunotherapy and symptomatic treatment, but the other one died.  Conclusions Anti-NMDA receptor encephalitis is a type of autoimmune encephalitis with or without neoplasms. The clinical symptoms are diversified but not specific. It is easy to be misdiagnosed as mental disorder in early stage. Detection of anti-NMDA receptor antibody in serum and CSF is a distinctive method to confirm the disease. Most cases have good prognosis after receiving timely and comprenensive treatment, but the prognosis of patients with serious symptoms is usually poor.

DOI: 10.3969/j.issn.1672-6731.2018.06.013