Anti-N-methyl-D-aspartate receptor encephalitis associated with peripheral nerve injury: A case report
Authors
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Fangjie Huang 
Department of Neurology, Yuquan Hospital of Tsinghua University
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Shimei Zhou
Department of Neurology, Yuquan Hospital of Tsinghua University
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Mangsuo Zhao
Department of Neurology, Yuquan Hospital of Tsinghua University
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Jing Wang
Department of Neurology, Yuquan Hospital of Tsinghua University
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Jingfen Huang
Department of Neurology, Yuquan Hospital of Tsinghua University
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Hongzhi Guan
Department of Neurology, Peking Union Medical College Hospital
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Liyan Qiao
Department of Neurology, Yuquan Hospital of Tsinghua University
DOI:
https://doi.org/10.30564/jams.v3i2.1766Abstract
A patient with Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis presented with quadriplegia and multiple peripheral neuropathy with axonal lesion, confirmed by electrophysiological examination. The muscle strength in the limbs of the patient gradually recovered almost completely, accompanied by the reversal of neuroelectrophysiological symptoms, and the improvement of clinical manifestations, including consciousness, respiration and cognitive function. It was revealed that the neuropathy in NMDAR encephalitis involved motor or sensorimotor nerves more than pure sensory nerves. No autoantibodies were detectable, in contrast to other anti-NMDAR overlapping syndromes. Although the underlying mechanism remains unclear, it may be associated with autoimmune generalization. In conclusion, when patients with NMDAR encephalitis present with severe limb paralysis, the possibility of peripheral nerve damage should be considered.
Keywords:
Anti-NMDAR encephalitis, Peripheral nerve disease, Multiple peripheral neuropathy, Autoimmune generalization, Overlapping syndromeReferences
[1] Dalmau J, Tuzun E, Wu H Y, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma[J]. Ann Neurol, 2007,61(1):25-36.
[2] Qin K, Wu W, Huang Y, et al. Anti-N-methyl-D-aspartate receptor(NMDAR) antibody encephaliti presents in atypical types and coexists with neuromyelitis optica spectrum disorder or neurosyphilis[J]. BMC Neurology, 2017,17(1).
[3] Coggeshall R E, Carlton S M. Ultrastructural analysis of NMDA, AMPA, and kainate receptors on unmyelinated and myelinated axons in the periphery[J]. J Comp Neurol, 1998,391(1):78-86.
[4] Miya K, Takahashi Y, Mori H. Anti-NMDAR autoimmune encephalitis[J]. Brain Dev, 2014,36(8):645-652.
[5] Graus F，Titulaer MJ，Balu R，et al.A clinical approach to diagnosis of autoimmune encephalitis[J].Lancet Neurol，2016，15：391-404.
[6] Tojo K, Nitta K, Ishii W, et al. A Young Man with Anti-NMDAR Encephalitis following Guillain-Barre Syndrome[J]. Case Rep Neurol, 2011,3(1):7-13
[7 ]Xu Xianhao. Enhanced collaborative clinical and basic research on myasthenia gravis [J].Chinese Journal of Neuroimmunology and Neurology, 2000 (4): 195-196.
[8] Hatano T, Shimada Y, Kono A, et al. Atypical Miller Fisher syndrome associated with glutamate receptor antibodies[J]. Case Reports,2011,2011(mar021):r820103228.
[9] Titulaer M J, Höftberger R, Iizuka T, et al. Overlapping demyelinating syndromes and anti-N-methyl-D-aspartate receptor encephalitis[J]. Annals of Neurology,2014, 75(3):411-428.
[10] Hacohen Y, Absoud M, Hemingway C, et al. NMDA receptor antibodies associated with distinct white matter syndromes[J]. Neurol Neuroimmunol Neuroinflamm, 2014,1(1):e2.
[11] Baheerathan A1, Brownlee WJ2, Chard DT et al. Antecedent anti-NMDA receptor encephalitis in two patients with multiple sclerosis[J]. Mult Scler Relat Disord. 2017 Feb;12:20-22.
[12] Wei Y C, Huang C C, Liu C H, et al. Peripheral neuropathy in limbic encephalitis with anti-glutamate receptor antibodies: Case report and systematic literature review[J]. Brain Behav, 2017,7(9):e779.
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Copyright © 2020 Fangjie Huang, Shimei Zhou, Mangsuo Zhao, Jing Wang, Jingfen Huang, Hongzhi Guan, Liyan Qiao
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.