Anti-N-methyl-D-aspartate receptor antibodies: A potentially treatable cause of encephalitis in the intensive care unit

作者：Davies Gerard; Irani Sarosh R; Coltart Cordelia; Ingle Gordon; Amin Yogen; Taylor Christopher; Radcliffe Jeremy; Hirsch Nicholas P; Howard Robin S; Vincent Angela; Kullmann Dimitri M^*

来源：Critical Care Medicine, 2010, 38(2): 679-682.

DOI：10.1097/CCM.0b013e3181cb0968

• NMDA receptor
• encephalitis
• ovarian teratoma
• neurological intensive care
• hyperkinetic

Objective: To report the occurrence of an unusual neurologic disorder requiring admission to the intensive care unit.
Design: Analysis of an observational cohort study of 31 patients with encephalitis admitted over a 4-yr period.
Setting: Neurologic intensive care unit in a tertiary referral center.
Patients: We identified N-methyl-D-aspartate receptor antibodies in six patients (two male and four female). All seropositive patients presented with a psychiatric prodrome, before developing seizures and obtundation requiring intensive care unit admission. They exhibited limb and truncal stereotypies and orofacial dyskinesias upon weaning sedation. Two patients had ovarian tumors.
Interventions: Patients were treated with sedation, antiepileptic drugs, and immunotherapy. One patient received a magnesium infusion and ketamine.
Measurements and Main Results: N-methyl-D-aspartate receptor antibodies were identified in serum samples by an immunofluorescent cell-based assay. Three patients made a good but slow recovery; two were left with severe neurologic deficits; and one died after return to the referring hospital. These patients accounted for approximately 20% of all patients admitted with encephalitis to this referral center.
Conclusions. N-methyl-D-aspartate receptor antibodies should be tested in patients with hyperkinetic encephalitis and neuropsychiatric prodrome admitted to the intensive care unit. The disorder is probably not rare and is potentially treatable. (Crit Care Med 2010; 38:679-682)

• 出版日期2010-2