Misdiagnosis Analysis of a Patient with Anti-N-methyl-D-Aspartate Receptor Encephalitis and Literature Review

LI Chen-xia; MA Kang-ping; LIANG Le; NI Jun; ZHANG Ying; FU Jing; LI Yun-lin

doi:10.3969/j.issn.1002-3429.2017.07.003

Abstract：Objective To investigate clinical features of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis in order to improve the diagnosis and treatment.Methods Clinical data one of a patient with NMDA receptor encephalitis was retrospectively analyzed, and related literature was also reviewed.Results This young female was admitted for intermittent loss of consciousness associated by limb vellicating for 6 days, and the effect for epileptic seizure was poor in other hospital.After transferring to our hospital, electroencephalography (EEG) examination showed that bilateral foreheads temporal intermittent slow waveform, and no obvious abnormalities was found by brain magnetic resonance imaging (MRI) examination, so the primary diagnosis was epilepsy.Levetiracetam was given orally.During the course of treatment, she had fever, abnormally mental behavior, personality change, hallucinations and orofacial involuntary movement.Pelvic imaging examination suggested ovarian teratoma, and NMDA receptor encephalitis was highly suspected, and then the result of anti-NMDA receptor antibody examination for serum and cerebrospinal fluid was positive.NMDA receptor encephalitis was confirmed.The teratoma was exsected by surgery on the basis of immunotherapy, and the patient's neural and mental symptoms were disappeared, and the patient recovered completely and was discharged.Conclusion Young females with ovarian embryoma have unknown causes of mental symptom and movement disorders, the anti-NMDA receptor encephalitis should be highly considered, and anti-NMDA receptor antibody examination for serum and cerebrospinal fluid can confirmed the diagnosis.