Clinical analysis of patients with anti-N-methyl-D-aspartate receptor encephalitis: a report of 3 cases

Abstract

Objective To explore the clinical features, laboratory test results, diagnosis, treatment and prognosis of patients with anti-N-methyl-D-aspartic acid receptor (NMDAR) encephalitis. Methods A retrospectives analysis of clinical characteristics, laboratory test, treatment and prognosis of 3 patients with NMDRA encephalitis, admitted to our hospital from February 2012 to November 2014, was performed in our study. Results The most predominant symptoms of 3 patients with anti-NMDAR encephalitis included fever, psychiatric behavioral disturbances, seizures, orofacial dyskinesias and movement disorders and autonomic dysfunction. One patient had immature ovarian teratoma and one had mature mediastinal teratoma. Anti-NMDAR antibody was positive in serum and cerebrospinal fluid of two patients with teratoma, and anti-NMDAR antibody was positive in cerebrospinal fluid and negative in serum of one patient without tumour; all three patients showed abnormal electroencephalography, and 2 had increased signal on MR imaging T2 sequences or fluid-attenuated inversion. Patients were responsive to early immunotherapy and tumour resection. Conclusion The patient with NMDAR encephalitis presented with characteristic clinical manifestations; detection of anti-NMDAR antibody in serum and cerebrospinal fluid may be important for early diagnosis; early immunotherapy and tumour resection are effective for patients with NMDAR encephalitis. Key words: Receptor; Anti-N-methyl-D-aspartic acid; Encephalitis; Autoimmune disease