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[摘要] 目的 分析抗N-甲基-D-天冬氨酸（NMDA）受体脑炎病人的临床及MRI特征，为其诊断提供参考。
方法 回顾性分析23例经临床确诊的抗NMDA受体脑炎病人的临床和影像学资料，总结其主要临床表现及MRI特征。
结果 23例病人中女14例（60.9%），男9例（39.1%），年龄6～92岁（其中≥18岁12例）。首发症状以精神行为异常（9/23）和癫痫发作（6/23）最常见;病程中出现精神行为异常（19/23）、癫痫发作（15/23）、不自主运动（15/23）、意识障碍（15/23）、认知功能障碍（9/23）及自主神经功能障碍（6/23）等症状。精神行为异常在成年病人中的发生率较高（χ2=5.282，P<0.05），癫痫在未成年病人中发生率较高（χ2=6.135，P<0.05）。23例病人中MRI表現异常9例（39.1%），均为多发病灶，其中对称性多发2例，非对称性多发7例。病灶部位包括额叶、顶叶各7例，颞叶6例，海马4例，枕叶3例，岛叶3例，脑干2例，基底核2例，丘脑1例。病灶仅累及皮质灰质2例，累及皮质灰质及皮质下白质4例，包括深部神经核团混合受累3例。病灶形态呈斑片、团片样及脑回样，受累皮质显示肿胀。病灶T1WI表现为等信号、低信号，T2WI、T2-FLAIR序列表现为高信号，3例病灶内DWI呈稍高、高信号，1例病灶内出现淡薄片样强化。
结论 抗NMDA受体脑炎临床表现复杂多样，成年与未成年病人分别以精神行为异常与癫痫发作为典型临床表现和首发表现;病灶MRI表现以多发、不完全对称性、范围广为特点，可累及皮质、皮质下白质及深部神经核团。
[关键词] 抗N-甲基-D-门冬氨酸受体脑炎;磁共振成像;临床表现
[中图分类号] R745
[文献标志码] A
[文章编号] 2096-5532（2021）05-0756-05
doi：10.11712/jms.2096-5532.2021.57.139
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20210706.1554.011.html;2021-07-06 17：31：17
CLINICAL AND MRI FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR ENCEPHALITIS
QIN Shanshan， WANG Chengjian， SU Huawei， GAO Song， QIAO Binglong， REN Yande
（Department of Radiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China）
[ABSTRACT] Objective To analyze the clinical and MRI characteristics of anti-N-methyl-D-aspartate （anti-NMDA） receptor encephalitis， and to provide a reference for the diagnosis of the disease.
Methods We retrospectively analyzed the clinical and imaging data of 23 patients with anti-NMDA receptor encephalitis， and summarized their main clinical manifestations and MRI features.
Results Among the 23 patients，14 cases （60.9%） were female and 9 cases （39.1%） were male. These patients were aged from 6 to 92 years， and 12 of them were ≥18 years old. The most common initial symptoms were mental and behavioral abnorma-
lities （9/23） and epileptic seizure （6/23）. In total， mental and behavioral abnormalities occurred in 19 of 23 patients， epileptic seizure in 15 of 23 patients， involuntary movement in 15 of 23 patients， disturbance of consciousness in 15 of 23 patients， cognitive dysfunction in 9 of 23 patients， and autonomic dysfunction in 6 of 23 patients. The incidence of mental and behavioral abnormalities was significantly higher in adult patients （χ2=5.282，P<0.05）， and the incidence of epilepsy was significantly higher in juvenile patients （χ2=6.135，P<0.05）. MRI findings were abnormal in 9 of 23 patients （39.1%）， all being multiple lesions （symmetrical multiple lesions in 2 cases and asymmetric multiple lesions in 7 cases）. The lesions involved the frontal lobe （7 cases）， parietal lobe （7 cases）， temporal lobe （6 cases）， hippocampus （4 cases）， occipital lobe （3 cases）， insula （3 cases）， brainstem （2 cases）， basal ganglia （2 cases）， and thalamus （1 case）. Two cases had involvement of only cortical gray matter， and 4 cases had involvement of cortical gray matter and subcortical white matter， among which 3 cases also had involvement of deep nerve nuclei. The lesions were in patchy， mass-like， or gyriform appearance. The affected cortices showed swelling. The lesions showed isointensity or hypointensity on T1-weighted images and hyperintensity on T2-weighted images and T2-weighted fluid-attenuated inversion recovery sequences. Three cases presented with slightly hyperintense or hyperintense lesions on diffusion-weighted images， and one case pre-
方法 回顾性分析23例经临床确诊的抗NMDA受体脑炎病人的临床和影像学资料，总结其主要临床表现及MRI特征。
结果 23例病人中女14例（60.9%），男9例（39.1%），年龄6～92岁（其中≥18岁12例）。首发症状以精神行为异常（9/23）和癫痫发作（6/23）最常见;病程中出现精神行为异常（19/23）、癫痫发作（15/23）、不自主运动（15/23）、意识障碍（15/23）、认知功能障碍（9/23）及自主神经功能障碍（6/23）等症状。精神行为异常在成年病人中的发生率较高（χ2=5.282，P<0.05），癫痫在未成年病人中发生率较高（χ2=6.135，P<0.05）。23例病人中MRI表現异常9例（39.1%），均为多发病灶，其中对称性多发2例，非对称性多发7例。病灶部位包括额叶、顶叶各7例，颞叶6例，海马4例，枕叶3例，岛叶3例，脑干2例，基底核2例，丘脑1例。病灶仅累及皮质灰质2例，累及皮质灰质及皮质下白质4例，包括深部神经核团混合受累3例。病灶形态呈斑片、团片样及脑回样，受累皮质显示肿胀。病灶T1WI表现为等信号、低信号，T2WI、T2-FLAIR序列表现为高信号，3例病灶内DWI呈稍高、高信号，1例病灶内出现淡薄片样强化。
结论 抗NMDA受体脑炎临床表现复杂多样，成年与未成年病人分别以精神行为异常与癫痫发作为典型临床表现和首发表现;病灶MRI表现以多发、不完全对称性、范围广为特点，可累及皮质、皮质下白质及深部神经核团。
[关键词] 抗N-甲基-D-门冬氨酸受体脑炎;磁共振成像;临床表现
[中图分类号] R745
[文献标志码] A
[文章编号] 2096-5532（2021）05-0756-05
doi：10.11712/jms.2096-5532.2021.57.139
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20210706.1554.011.html;2021-07-06 17：31：17
CLINICAL AND MRI FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR ENCEPHALITIS
QIN Shanshan， WANG Chengjian， SU Huawei， GAO Song， QIAO Binglong， REN Yande
（Department of Radiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China）
[ABSTRACT] Objective To analyze the clinical and MRI characteristics of anti-N-methyl-D-aspartate （anti-NMDA） receptor encephalitis， and to provide a reference for the diagnosis of the disease.
Methods We retrospectively analyzed the clinical and imaging data of 23 patients with anti-NMDA receptor encephalitis， and summarized their main clinical manifestations and MRI features.
Results Among the 23 patients，14 cases （60.9%） were female and 9 cases （39.1%） were male. These patients were aged from 6 to 92 years， and 12 of them were ≥18 years old. The most common initial symptoms were mental and behavioral abnorma-
lities （9/23） and epileptic seizure （6/23）. In total， mental and behavioral abnormalities occurred in 19 of 23 patients， epileptic seizure in 15 of 23 patients， involuntary movement in 15 of 23 patients， disturbance of consciousness in 15 of 23 patients， cognitive dysfunction in 9 of 23 patients， and autonomic dysfunction in 6 of 23 patients. The incidence of mental and behavioral abnormalities was significantly higher in adult patients （χ2=5.282，P<0.05）， and the incidence of epilepsy was significantly higher in juvenile patients （χ2=6.135，P<0.05）. MRI findings were abnormal in 9 of 23 patients （39.1%）， all being multiple lesions （symmetrical multiple lesions in 2 cases and asymmetric multiple lesions in 7 cases）. The lesions involved the frontal lobe （7 cases）， parietal lobe （7 cases）， temporal lobe （6 cases）， hippocampus （4 cases）， occipital lobe （3 cases）， insula （3 cases）， brainstem （2 cases）， basal ganglia （2 cases）， and thalamus （1 case）. Two cases had involvement of only cortical gray matter， and 4 cases had involvement of cortical gray matter and subcortical white matter， among which 3 cases also had involvement of deep nerve nuclei. The lesions were in patchy， mass-like， or gyriform appearance. The affected cortices showed swelling. The lesions showed isointensity or hypointensity on T1-weighted images and hyperintensity on T2-weighted images and T2-weighted fluid-attenuated inversion recovery sequences. Three cases presented with slightly hyperintense or hyperintense lesions on diffusion-weighted images， and one case pre-