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目的探讨视神经脊髓炎合并抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的临床特征。方法报道本院收治的1例视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎的临床特点及诊治经过,并结合文献分析该病的特征。结果患者为21岁女性,表现为腹泻后急性起病的下肢麻木无力、昏睡、视物模糊;MRI示双侧基底节、海马、桥臂、齿状回、延髓背侧多发异常信号,同时伴有颈髓多发条片状长T2异常信号。脑脊液NMDA受体抗体阳性,血清和脑脊液水通道蛋白4(AQP4)抗体阳性,合并心动过缓并发症,筛查未发现肿瘤;经激素冲击、丙种球蛋白及免疫抑制剂治疗后症状逐渐好转至痊愈。结论视神经脊髓炎合并抗N-甲基-D-天冬氨酸受体脑炎可以在感染后起病,症状和影像学主要表现为两种疾病的叠加,可出现心动过缓并发症,早期积极行免疫治疗效果较好。
Objective To investigate the clinical features of neuromyelitis combined with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. Methods The clinical features, diagnosis and treatment of one case of optic neuromyelitis combined with anti-N-methyl-D-aspartate receptor encephalitis admitted in our hospital were reported and the characteristics of the disease were analyzed in combination with the literature. Results The patient was 21 years old and showed numbness, drowsiness and blurred vision in the lower extremities with acute onset of diarrhea. MRI showed abnormal signals of multiple basal ganglia, hippocampus, hippocampus, dentate gyrus and dorsal medulla oblongata There are multiple spinal cord spinal cord T2 abnormal signal. Cerebrospinal fluid NMDA receptor antibody positive, serum and CSF AQP4 antibody positive, with bradycardia complications, no tumors were detected by screening; hormones shock, gamma globulin and immunosuppressive agents after treatment symptoms gradually improved to get well. Conclusions Optic neuromyelitis combined with anti-N-methyl-D-aspartate receptor encephalitis can occur after infection. Symptoms and radiographies mainly show the superposition of the two diseases, which may lead to complications of bradycardia. Early Active immunotherapy is better.