Anti-NMDA receptor encephalitis in older adults: A systematic review of case reports

紧张症 脑炎 红细胞增多 精神病 儿科 医学 鉴别诊断 磁共振成像 精神科 病理 精神分裂症(面向对象编程) 脑膜炎 放射科 免疫学 病毒
作者
Eloi Giné-Servén,Jordi Serra-Mestres,Maria Martinez-Ramirez,Ester Boix-Quintana,Eva Davi-Loscos,Nicolau Guanyabens,Virginia Casado,Desiree Muriana,Cristina Torres-Rivas,Jorge Cuevas-Esteban,Javier Labad
出处
期刊:General Hospital Psychiatry [Elsevier]
卷期号:74: 71-77 被引量:5
标识
DOI:10.1016/j.genhosppsych.2021.11.006
摘要

To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients.A systematic literature review using PubMed and Scopus of all published case reports of NMDARE was undertaken, from database inception to June 2020. From this, cases reporting on patients older than 65 years of age and whose diagnosis was confirmed by the presence of anti-NMDAR antibodies in CSF were selected.23 case reports fulfilling the study's criteria were found. Median age was 70.1 years (range 65-84), fourteen were female (60.9%), and mostly presented with acute behavioral and cognitive changes (95.7%). Atypical psychosis occurred in eleven patients (47.8%) with a sudden onset and fluctuating clinical pattern of delusions (39.1%), hallucinations (30.4%), and motility disturbances (34.8%) including catatonia (17.4%). Nine patients presented with seizures (39.1%). Pleocytosis in CSF (>5 WBC) was described in twelve cases (52.2%). Eleven cases (47.8%) had abnormal brain magnetic resonance imaging (MRI) scans with limbic inflammatory lesions. Thirteen patients had an abnormal EEG (56.5%).NMDARE should be included in the differential diagnosis of older patients who present with new psychiatric episodes, especially when characterized by sudden onset psychotic polymorphic symptomatology, fluctuating course with marked cognitive decline, and with catatonic features.
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