PDF(Pubmed)
Abstract：
BACKGROUND: Persistent somatoform pain disorder (PSPD) is often the initial diagnosis in patients seeking treatment in psychiatric departments, making it challenging to consider organic nervous system diseases. However, autoimmune encephalitis can present with atypical initial symptoms, leading to misdiagnosis or missed diagnosis. Lumbar puncture, with antibody support, plays a crucial role in diagnosing autoimmune encephalitis.
METHODS: This report describes a 40-year-old male adult patient who was initially diagnosed with persistent somatoform pain disorder in 2022. The patient reported a reduction in pain while resting on his back. There were no fever or relevant medical history. Despite 8 months of symptomatic treatment, the symptoms did not improve. Moreover, the patient developed confusion, gibberish speech, non-cooperation during questioning, and increased frequency and amplitude of upper limb convulsions. Lumbar puncture revealed elevated protein levels and protein-cell dissociation. The autoimmune encephalitis antibody NMDAR (+) was detected, leading to a diagnosis of autoimmune encephalitis (NMDAR).
CONCLUSIONS: Autoimmune encephalitis (NMDAR), starting with persistent somatoform pain (PSPD), often presents with atypical symptoms and can be easily misdiagnosed. Therefore, it is important to consider the possibility of organic nervous system disease in time, and to test serum or cerebrospinal fluid antibodies to rule out organic nervous system disease after symptomatic treatment of mental disorders is ineffective. This approach facilitates the early diagnosis of autoimmune encephalitis and other underlying organic neurological disorders.
METHODS: This report describes a 40-year-old male adult patient who was initially diagnosed with persistent somatoform pain disorder in 2022. The patient reported a reduction in pain while resting on his back. There were no fever or relevant medical history. Despite 8 months of symptomatic treatment, the symptoms did not improve. Moreover, the patient developed confusion, gibberish speech, non-cooperation during questioning, and increased frequency and amplitude of upper limb convulsions. Lumbar puncture revealed elevated protein levels and protein-cell dissociation. The autoimmune encephalitis antibody NMDAR (+) was detected, leading to a diagnosis of autoimmune encephalitis (NMDAR).
CONCLUSIONS: Autoimmune encephalitis (NMDAR), starting with persistent somatoform pain (PSPD), often presents with atypical symptoms and can be easily misdiagnosed. Therefore, it is important to consider the possibility of organic nervous system disease in time, and to test serum or cerebrospinal fluid antibodies to rule out organic nervous system disease after symptomatic treatment of mental disorders is ineffective. This approach facilitates the early diagnosis of autoimmune encephalitis and other underlying organic neurological disorders.
摘要：
背景：持续性躯体形式疼痛障碍（PSPD）通常是在精神科寻求治疗的患者的最初诊断，这使得考虑器质性神经系统疾病具有挑战性。然而,自身免疫性脑炎可以表现为不典型的初始症状，导致误诊或漏诊。腰椎穿刺,在抗体支持下，在诊断自身免疫性脑炎中起着至关重要的作用。
方法：本报告描述了一名40岁的成年男性患者，该患者最初于2022年被诊断为持续性躯体形式疼痛障碍。患者报告背部休息时疼痛减轻。无发热或相关病史。尽管有8个月的对症治疗，症状没有改善。此外，病人出现了混乱，胡言乱语，提问时不合作，上肢抽搐的频率和幅度增加。腰椎穿刺显示蛋白质水平升高和蛋白质细胞解离。检测自身免疫性脑炎抗体NMDAR(+),导致自身免疫性脑炎（NMDAR）的诊断。
结论：自身免疫性脑炎（NMDAR），从持续性躯体形式疼痛（PSPD）开始，常表现为不典型症状,易误诊。因此,重要的是要及时考虑器质性神经系统疾病的可能性，并检测血清或脑脊液抗体，以排除器质性神经系统疾病后对精神障碍的对症治疗无效。这种方法有助于早期诊断自身免疫性脑炎和其他潜在的器质性神经系统疾病。
方法：本报告描述了一名40岁的成年男性患者，该患者最初于2022年被诊断为持续性躯体形式疼痛障碍。患者报告背部休息时疼痛减轻。无发热或相关病史。尽管有8个月的对症治疗，症状没有改善。此外，病人出现了混乱，胡言乱语，提问时不合作，上肢抽搐的频率和幅度增加。腰椎穿刺显示蛋白质水平升高和蛋白质细胞解离。检测自身免疫性脑炎抗体NMDAR(+),导致自身免疫性脑炎（NMDAR）的诊断。
结论：自身免疫性脑炎（NMDAR），从持续性躯体形式疼痛（PSPD）开始，常表现为不典型症状,易误诊。因此,重要的是要及时考虑器质性神经系统疾病的可能性，并检测血清或脑脊液抗体，以排除器质性神经系统疾病后对精神障碍的对症治疗无效。这种方法有助于早期诊断自身免疫性脑炎和其他潜在的器质性神经系统疾病。
