背景:单纯疱疹病毒性脑炎(HSE)经常引发继发性抗N-甲基-D-天冬氨酸受体脑炎(NMDARE),但缺乏预测该实体(HSE-NMDARE)发生的标记。
方法:我们对2014年7月至2022年8月诊断为HSE-NMDARE的患者进行了回顾性描述,并将其与常规形式的HSE和NMDARE的患者进行了比较。
结果:在375例NMDARE患者中,包括13个HSE-NMDARE。中位年龄为19岁(0.5-73岁),4/13(31%)为4岁以下儿童,7/13(54%)为男性。HSE和NMDARE发病的中位时间为30天(21-46)。在NMDARE期间,症状不同于HSE,包括增加的行为变化(92%对23%,p=0.008),运动障碍(62%对0%,p=0.013),和自主神经失调(54%对0%,p=0.041)。与21例常规HSE患者相比,HSE-NMDARE患者通常在初始MRI上达到严重程度相关标准,广泛病变(11/11,100%vs10/21,48%,p=0.005)和双侧扩散加权成像序列异常(9/10,90%vs6/21,29%,p=0.002)。与198例常规NMDARE患者相比,HSE-NMDARE患者更常见的是男性(7/13,54%vs43/198,22%;p=0.015)和儿童<4(4/13,31%vs14/198,7%;p=0.016),12个月MRS更差(2[1-6]对1[0-6],p=0.023)。
结论:此处,HSE-NMDARE患者的长期预后比常规NMDARE患者差.与常规HSE相比,我们报告的HSE-NMDARE初始MRI的严重程度相关标准比率更高,这可能有助于识别HSE-NMDARE风险较高的患者。
BACKGROUND: Herpes simplex virus encephalitis (HSE) frequently triggers secondary anti-N-methyl-D-aspartate receptor encephalitis (NMDARE), but markers predicting the occurrence of this entity (HSE-NMDARE) are lacking.
METHODS: We conducted a retrospective description of patients with HSE-NMDARE diagnosed between July 2014 and August 2022 and compared them to both patients with regular forms of HSE and NMDARE.
RESULTS: Among the 375 patients with NMDARE, 13 HSE-NMDARE were included. The median age was 19 years (0.5-73), 4/13 (31%) were children < 4 years old, and 7/13 (54%) were male. The median time between HSE and NMDARE onset was 30 days (21-46). During NMDARE, symptoms differed from HSE, including increased behavioral changes (92% vs 23%, p = 0.008), movements disorders (62% vs 0%, p = 0.013), and dysautonomia (54% vs 0%, p = 0.041). Compared to 21 patients with regular HSE, patients with HSE-NMDARE more often achieved severity-associated criteria on initial MRIs, with extensive lesions (11/11, 100% vs 10/21, 48%, p = 0.005) and bilateral diffusion-weighted imaging sequence abnormalities (9/10, 90% vs 6/21, 29%, p = 0.002). Compared to 198 patients with regular NMDARE, patients with HSE-NMDARE were more frequently males (7/13, 54% vs 43/198, 22%; p = 0.015) and children < 4 (4/13, 31% vs 14/198, 7%; p = 0.016), with a worse 12-month mRS (2[1-6] vs 1[0-6], p = 0.023).
CONCLUSIONS: Herein, patients with HSE-NMDARE have a poorer long-term prognosis than patients with regular NMDARE. We report a greater rate of severity-associated criteria on initial MRIs for HSE-NMDARE compared to regular HSE, which may help identify patients with higher risk of HSE-NMDARE.