摘要
目的:探讨首发为精神症状的抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点及误诊分析。方法:回顾性分析22例误诊为精神疾病的抗NMDAR脑炎患者的临床资料。结果:22例患者为少年到中年人;均以急性或亚急性起病,首发症状为精神及行为紊乱;均误诊为“精神障碍”收住精神科,并接受相应的精神科药物或电休克治疗,但无效。临床辅助检查(脑电图、头颅MRI及CT)无特异性;脑脊液抗NMDAR抗体检测均为阳性而确诊。结论:抗NMDAR脑炎患者早期以精神症状为主要表现,易误诊为精神疾病,但常规精神科治疗无效;对可疑患者应脑脊液抗NMDAR抗体检测以避免误诊。
Objective:To investigate the clinical characteristics and misdiagnosis of anti-N-methyl-D-aspartic acid receptor(NMDAR)encephalitis with mental symptoms.Method:The clinical data of 22 patients with anti NMDAR encephalitis misdiagnosed as mental diseases were analyzed retrospectively.Results:22 patients were young to middle-aged;the onset was acute or subacute,and their first symptoms were mental and behavioral disorders;they were misdiagnosed as"mental disorder",admitted to the psychiatric department,and received corresponding psychiatric drug treatment or electroconvulsive treatment,yet the treatments were ineffective.There was no specificity in the clinical auxiliary examination(EEG,cranial MRI and CT);the diagnoses were confirmed as their cerebrospinal fluid anti NMDAR antibody tests were positive.Conclusion:The main manifestation of anti NMDAR encephalitis in the early stage is mental symptoms,which is easy to be misdiagnosed as a mental disease,but the routine psychiatric treatment is ineffective;cerebrospinal fluid anti NMDAR antibody tests should be detected in suspicious patients to avoid misdiagnoses.
作者
胡德凤
王征
HU De-feng;WANG Zheng(the Seventh People's Hospital of Hangzhou,Hangzhou 310013,China)
出处
《临床精神医学杂志》
CAS
2022年第2期139-140,共2页
Journal of Clinical Psychiatry
