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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >P.080 Effects of REM sleep in anti-NMDA receptor encephalitis with extreme delta brush pattern
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P.080 Effects of REM sleep in anti-NMDA receptor encephalitis with extreme delta brush pattern

机译：P.080 REM睡眠在抗NMDA受体脑炎与极端三角形刷子图案的影响

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Background: Seizures are rare in REM sleep. To our knowledge, the effects of different sleep stages in anti-NMDA encephalitis have not been studied. Methods: Case report. Results: 32 year-old healthy female presented with acute fluctuating level of consciousness with episodic impulsivity, disorientation, and emotional outbursts following 3 days of headache. Her temperature was 37.8°C and she was started on ceftriaxone, vancomycin, and acyclovir. CSF only showed a total nuclear cell count of 182 and pleocytosis. MRI revealed increased T2 hyperintense right lateral temporal and parietal cortical thickening. EEG revealed right frontotemporal seizures with left sided rhythmic jerking, and an extreme delta brush pattern. Interestingly, seizures and extreme delta brush disappeared in REM sleep. After HSV PCR was negative, she was immunosuppressed with corticosteroids, IVIG, rituximab, and cyclophosphamide, given the extreme delta brush pattern. Repeat CSF analysis eventually yielded highly positive anti-NMDA antibodies. Ten weeks later, she became seizure free. Conclusions: For the first time, we report REM sleep in a case of anti-NMDA encephalitis during which there was absence of extreme delta brush and ictal EEG patterns. This observation may provide insight into the ongoing debate over whether extreme delta brush is an ictal EEG pattern.
机译：背景：癫痫发作在REM睡眠中很少见。据我们所知，尚未研究不同睡眠阶段对抗NMDA脑炎的影响。方法：案例报告。结果：32岁的健康女性呈现出急性波动的意识水平，在头痛3天后的情节冲动，迷失化和情绪爆发。她的温度为37.8°C，她开始于头孢曲松，万古霉素和阿昔洛韦。 CSF仅显示总核细胞计数为182和膜质衰退。 MRI揭示了T2超前右侧颞延长颞和榫术加厚。脑电图揭示了左侧节奏抖动和极端三角形刷图案的正确思考癫痫发作。有趣的是，癫痫发作和极端三角形刷子在Rem睡眠中消失了。在HSV PCR为阴性后，鉴于极端三角形刷子图案，她用皮质类固醇，IVIG，RITUXIMAB和环磷酰胺免疫抑制。重复CSF分析最终产生高度阳性抗NMDA抗体。十个星期后，她自由癫痫发作。结论：首次，在抗NMDA脑炎的情况下，我们报告REM睡眠，在此期间没有极端的DELTA刷和ICTAL EEG模式。该观察可能会对持续的辩论提供洞察，这些争论是否是Extreme Delta Brush是ICTAL EEG模式。

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