How should I manage a patient with presumed encephalitis and neuropsychiatric symptoms?

[摘要] A previously healthy 12-year-old girl is admitted to your service with new-onset seizures, disorientation, and visual hallucinations. The illness began 10 days before admission with fever, malaise, vomiting, and headache. Despite a supple neck, lumbar puncture in the emergency department revealed cerebrospinal fluid (CSF) pleocytosis with normal glucose and protein levels, a negative Gram stain, and a negative enteroviral polymerase chain reaction (PCR) result. Supportive therapy and acyclovir are initiated. Are any other treatments indicated? Although this question will depend on further diagnostic evaluation for entities such as acute disseminated encephalomyelitis, ingestions, and even brain tumors, many practitioners will place encephalitis, likely infectious, at the top of their differential diagnoses on the basis of fever, encephalopathy, and CSF pleocytosis. How many practitioners would consider autoimmune encephalitis secondary to anti- N -Methyl-D-aspartate receptor (NMDAR) antibodies in this patient with a febrile viral prodrome and neuropsychiatric symptoms?Anti-NMDAR encephalitis results from an antibody-mediated immune response against the NR1 subunit of the NMDA receptor. Psychiatric and behavioral symptoms are prominent, as are seizures (usually generalized tonic-clonic), dyskine-sias, …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob