Misdiagnosis Analysis of 2 Patients with Anti-NMDAR Encephalitis

CHENG Na; HUANG Yong-hua; SHI Wen-Lei

doi:10.3969/j.issn.1002-3429.2016.12.017

Abstract：Objective To investigate clinical features of anti-NMDAR( N-methyl-D-aspartate receptor) encephalitis in order to reduce misdiagnosis and mistreatment. Methods Clinical data of 2 patients with anti-NMDAR encephalitis was retro-spectively analyzed, and relevant literature was reviewed. Results The 2 patients were admitted for mental and behavioral disorders, consciousness disorders and seizure disorder. One had been treated with antiviral therapy for diagnosis of viral en-cephalitis, while another has been treated with antipsychotic drugs for diagnosis of dissociative disorders. After they were ad-mitted to our department, lumbar puncture and blood test showed that anti-NMDAR antibodies were strongly positive after com-prehensive analysis of possibility of autoimmune encephalitis, and then anti-NMDAR encephalitis was confirmed. Treatments such as glucocorticoid and immune globulin were given, and one patient was treated with symptomatic treatments such as Rit-uximab, Cyclophosphamide and anti-epilepsy after surgical teratoma resection, while another patient was discharged after symptoms improvement. During follow-up for 3 months to 1 year, one patient had teratoma recurrence, and another patient had symptom fluctuation, and was discharged after condition was improved by symptomatic treatment during readmission. Conclu-sion Clinical manifestation of anti-NMDAR encephalitis is nonspecific, so it is easily misdiagnosed. Timely relevant antibody detection, performing tumor resection immediately and early immunosuppressant treatment for patients with tumors are impor-tant to avoid misdiagnosis and mistreatment.