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目的提高对发病酷似单纯疱疹病毒脑炎(Herpes simplex encephalitis,HSE)的抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎的认识。方法报道2例发病酷似单纯疱疹病毒脑炎的抗NMDA受体脑炎,并复习相关文献。结果 2例患者均急性起病,表现为发热、抽搐、认知功能减退、精神行为异常等。脑MRI均未见异常。病例1、病例2脑脊液白细胞最高分别为20×10~6/L、21×10~6/L。脑脊液蛋白、葡萄糖以及氯化物水平均正常。2例患者早期均被诊断为HSE,并接受阿昔洛韦抗病毒治疗,但病情仍进展。抗NMDA受体抗体检测显示例1脑脊液及血液均阳性,例2脑脊液阳性,从而明确了抗NMDA受体脑炎的诊断。结论对脑MRI无异常,脑脊液白细胞无明显升高的边缘系统脑炎,应想到抗NMDA受体脑炎可能。
OBJECTIVE To improve the understanding of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis in patients with onset of herpes simplex encephalitis (HSE). Methods Two cases of anti-NMDA receptor encephalitis resembling herpes simplex virus encephalitis were reported and their related literatures were reviewed. Results 2 patients were acute onset, manifested as fever, convulsions, cognitive decline, mental and behavioral disorders. No abnormal brain MRI. Case 1, case 2 cerebrospinal fluid leukocytes were the highest 20 × 10 ~ 6 / L, 21 × 10 ~ 6 / L. Cerebrospinal fluid protein, glucose and chloride levels were normal. Two patients were diagnosed with HSE early, and received acyclovir antiviral therapy, but the condition is still progressing. Detection of anti-NMDA receptor antibodies showed that both cerebrospinal fluid and blood were positive in Example 2, and cerebrospinal fluid was positive in Example 2, thus confirming the diagnosis of anti-NMDA receptor encephalitis. Conclusion No abnormal brain MRI, no significant increase in cerebrospinal fluid leukocyte edge system encephalitis, should think of anti-NMDA receptor encephalitis may.