Recoverin是一种神经元特异性钙结合蛋白,主要位于视网膜和松果体中。很少有报道描述抗恢复蛋白抗体阳性脑炎的患者,并且没有报告与这种脑炎相关的精神病病例。我们报告了一名Cotard和Capgras妄想的抗恢复蛋白抗体阳性脑炎患者,该患者已成功接受电惊厥治疗(ECT)。病人是一名25岁的妇女。她表现出迷失方向,执行功能缺陷,上肢颤抖,全身性动骨样不自主运动,幻觉,失禁,发烧,导致她入院.一被录取,她抱怨Cotard妄想.各种诊断测试,包括脑脊液分析,抗体筛选,和大脑成像,平淡无奇,除了血清抗恢复素抗体阳性,非特异性的一般脑电图减慢和额叶和枕叶的局部脑血流量(rCBF)减少,在单光子发射计算机断层扫描中,基底神经节和脑桥的rCBF增加。她最终被诊断出患有抗恢复蛋白抗体阳性的脑炎,并接受了免疫球蛋白和类固醇治疗。她的神经症状暂时好转,但三个月后,精神症状,即,自杀念头和Cotard和Capgras妄想,被夸大了。ECT后,她的病情明显改善。总之,本报告提示,由于抗-recoverin抗体或其与神经元特异性钙结合蛋白的交叉反应导致的松果体功能障碍可能导致抗-recoverin抗体阳性脑炎中观察到的神经精神症状,如果免疫疗法证明无效,ECT可以是一种可行的治疗选择.此外,前额叶皮质rCBF降低可能与Capgras和Cotard妄想的临床特征有关。
Recoverin is a neuron-specific calcium-binding protein that is mainly located in the retina and pineal gland. Few
reports have described patients with anti-recoverin antibody-positive encephalitis, and no cases of psychosis associated with this encephalitis have been reported. We report a patient with anti-recoverin antibody-positive encephalitis with Cotard and Capgras delusions who was successfully treated with electroconvulsive therapy (
ECT). The patient was a 25-year-old woman. She exhibited disorientation, executive function deficits, tremors in the upper limbs, generalized athetoid-like involuntary movements, hallucinations, incontinence, and fever, which led to her admission to our hospital. Upon admission, she complained of Cotard delusions. Various diagnostic tests, including cerebrospinal fluid analysis, antibody screening, and brain imaging, were unremarkable, except for positivity for serum anti-recoverin antibodies, non-specific general slowing on electroencephalography and decreased regional cerebral blood flow (rCBF) in the frontal and occipital lobes, and increased rCBF in the basal ganglia and pons on single-photon emission computed tomography. She was eventually diagnosed with encephalitis positive for anti-recoverin antibodies and treated with immunoglobulins and steroids. Her neurological symptoms improved temporarily, but three months later, psychiatric symptoms, i.e., suicidal thoughts and Cotard and Capgras delusions, were exaggerated. After
ECT, her condition significantly improved. In conclusion, the present report suggests that pineal gland dysfunction due to anti-recoverin antibody or its cross-reactivity with neuron-specific calcium-binding proteins may contribute to the neuropsychiatric symptoms observed in anti-recoverin antibody-positive encephalitis and that
ECT can be a viable treatment option if immunotherapy proves ineffective. Additionally, decreased rCBF in the prefrontal cortex may be associated with the clinical features of Capgras and Cotard delusions.