​The child was caught in the grave at Qingming?

*The professional part involved in this article is only for medical professionals to read for reference.
Understanding Anti-NMDAR Encephalitis Some time ago during the Qingming holiday, 9-year-old Xiaohuan went back to his hometown with his parents and went to the grave for his deceased grandfather.

After returning to the city, Xiao Huan went to the remedial class non-stop.

As a result, my mother received an anxious call from the teacher before the end of the remedial class, asking the parents to come to the remedial class to pick up Xiaohuan.

 After the anxious mother came to the remedial class, she saw Xiao Huan, who was still quiet and sensible in the morning, like a different person.
She didn't listen to the teacher's instructions at all and walked back and forth in the classroom.

In desperation, her mother had to take Xiao Huan home, thinking that the child was just too tired and didn't want to make up lessons.

Unexpectedly, a day later, Xiao Huan appeared intermittently babbling, answering wrong questions, and restless.

The elders in the family all said that Xiaohuan was “infected by evil” when he went to his hometown to go to the grave.
Mom and Dad also thought it was “infected by evil”, but watching the child's nonsense, unanswered questions, and irritability became more and more serious, they anxiously took it with them.
The child came to the hospital to see a doctor.

 When we saw Xiao Huan, the 9-year-old slightly fat girl couldn't communicate normally with people at all.
She muttered words but didn't know what she was saying, and she was irritable and uncomfortable.

Seeing this symptom, we preliminarily judged that Xiao Huan was suffering from a special kind of encephalitis, but it was not "in the evil".

We immediately carried out relevant examinations for Xiaohuan: including routine blood biochemistry, cerebrospinal fluid, head MRI, EEG, chest radiograph, liver, gallbladder, pancreas, spleen, bilateral ovaries, and uterus ultrasound.

(Friends from other majors will surely whisper-why do ultrasounds of the ovaries and uterus? Please see later.

) The first result is cerebrospinal fluid: it seems—yes, it “looks”—it seems to be the cerebrospinal fluid result of a viral encephalitis, but Xiaohuan’s clinical manifestations are definitely not what a simple viral encephalitis can do.
Explained, because the diagnosis of viral encephalitis requires the detection of the virus in the cerebrospinal fluid or brain tissue, which is very difficult in reality, so clinically viral encephalitis is a diagnosis of exclusion, which means that other types need to be excluded Encephalitis.

 The second result is an electroencephalogram: the electroencephalogram indicates that the background rhythm has slowed down.

Electroencephalogram is a test that reflects the function of the cerebral cortex.
It can only tell us that there are some problems with Xiaohuan's cerebral cortex function.
It cannot be qualitative, that is, the cause cannot be determined.

 The subsequent head MRI and chest X-ray showed no abnormalities, but the results of ovarian ultrasound have brought us a breakthrough direction-suggesting ovarian teratoma.

 Later, more exciting laboratory results came back, and the immunological examination of Xiaohuan's cerebrospinal fluid also came out, and the anti-NMDAR antibody titer was significantly increased.

So far, Xiao Huan's diagnosis has been clear-it is a disease called "anti-NMDAR encephalitis", which is an autoimmune encephalitis.

 So what is autoimmune encephalitis? Autoimmune encephalitis generally refers to a type of encephalitis mediated by autoimmune mechanisms.

A part of autoimmune encephalitis can be associated with related tumors, called paraneoplastic autoimmune encephalitis; while paraneoplastic autoimmune encephalitis meets marginal encephalitis, it is called paraneoplastic limbic encephalitis.

 And anti-NMDAR encephalitis (N-methyl-D-aspartate-receptor, NMDAR) is the most important type of autoimmune encephalitis; in addition, autoimmune encephalitis also includes limbic encephalitis, other autoimmune Encephalitis syndrome.

 What are the symptoms of autoimmune encephalitis? Autoimmune encephalitis is common with prodromal symptoms such as fever and headache.

And anti-NMDAR encephalitis can occasionally occur after central nervous system viral infections such as herpes simplex virus encephalitis.

 Symptoms: The main symptoms of this type of encephalitis include abnormal mental behavior, cognitive impairment, memory loss, seizures, speech disorders, movement disorders, involuntary movements, limb tremors, dance-like movements, and even reflexes and decreased levels of consciousness And coma, autonomic dysfunction, etc.

 Other symptoms of autoimmune encephalitis can also be seen: such as sleep disorders: including insomnia, difficulty falling asleep, excessive daytime sleep, lethargy, sleep-wake cycle disturbances and so on.

For example, the symptoms of local cranial nerve damage include double vision, unsteady walking, and paralysis of limbs.

How is autoimmune encephalitis diagnosed? Let's go back and take a look at Xiao Huan's diagnosis process.

 The diagnosis of autoimmune encephalitis first requires a comprehensive analysis of the patient's clinical manifestations, cerebrospinal fluid examination, neuroimaging, and EEG results to determine that he has encephalitis, and then select autoimmune encephalitis-related antibody testing for diagnosis.

 Clinical manifestations: Xiaohuan is the clinical manifestation of autoimmune encephalitis such as abnormal mental behavior, dyskinesia, and involuntary movements.

Cerebrospinal fluid examination: immediately after admission, the doctor performed a cerebrospinal fluid examination and tested antibodies related to autoimmune encephalitis, and the relevant antibody report supports the clinician's judgment.

Imaging examination: More importantly, during the next examination, the doctor found that Xiao Huan had a teratoma in his ovary, and this teratoma was the culprit that caused Xiao Huan to suffer from autoimmune encephalitis.

So far, Xiao Huan's diagnosis has been clear at a glance; this is by no means an evil, but a special type of encephalitis.

 Of course, autoimmune encephalitis has its own diagnosis process and specifications.
If you are interested, you can refer to the "Chinese Experts Consensus on the Diagnosis and Treatment of Autoimmune Encephalitis", which contains more detailed and standardized diagnosis and treatment plans.  What are the treatments for autoimmune encephalitis? Because this is an autoimmune disease, the treatment of autoimmune encephalitis includes: 1.
Immunotherapy: including glucocorticoids, intravenous gamma globulin and other immune agents; 2.
Control of seizures: autoimmune Seizures caused by encephalitis are often difficult to control.
Broad-spectrum anti-epileptic drugs can be used.
If status epilepticus occurs, treatment should be carried out according to the principles of status epilepticus; 3.
Psychiatric symptoms: psychiatric drug olanzapine can be used, or Use sedative drugs; 4.
Other: If tumors are combined, comprehensive anti-tumor treatments such as surgery, radiotherapy and chemotherapy should be performed by relevant specialists.
During the anti-tumor treatment, immunotherapy for immune encephalitis should be maintained.

After discovering the tumor, our Xiaohuan also contacted the relevant operating department as soon as possible for surgical treatment.

 Having said so much, everyone must be very puzzled.
Why did Xiao Huan get this strange disease? Does it have anything to do with her going to the grave? Are there any causes and triggers for autoimmune encephalitis? ▎Tumor As mentioned above, autoimmune encephalitis is encephalitis mediated by autoimmune mechanisms.
Some autoimmune encephalitis can be combined with related tumors.
Therefore, tumors are a major cause of autoimmune encephalitis.

▎ In addition to infections, infections, especially viral infections, such as herpes simplex virus infection, Epstein-Barr virus infection, etc.
; of course, other pathogens such as streptococcal infection may also be a cause, and these are all under study.

▎Genetic factors Genetic factors are also important causes.
Once again, genetic factors are related to all diseases, and genetic factors are not genetic diseases.

 It is worth noting that tumors and infectious factors may only be related to some of the causes of autoimmune encephalitis, and there are many unknown causes that are under study.

This disease has only been recognized in 2005.
Fifteen years ago, medical experts discovered a new type of antibody in the cerebrospinal fluid of four female ovarian teratoma patients with neurological symptoms; in 2007, medical experts were similar Patients with teratoma confirmed that this antibody is an anti-NMDAR antibody, and the concept of anti-NMDAR encephalitis was proposed for the first time.

As for why Xiaohuan got this strange disease, it was related to her ovarian teratoma.
As for going to the grave, it might be induced by fatigue, which was just a coincidence.  How can we prevent this disease? We must pay attention to the prevention and treatment of infections, especially viral infections.
If there are symptoms of mental illness and consciousness disturbance due to viral infections, we must go to a regular medical institution as soon as possible to see a doctor.

 Usually work and rest should be combined to avoid fatigue and mood swings.

Because tiredness and mood swings can make our immune response abnormal.

Of course, these are also "cheats" to avoid other diseases.

 What is the prognosis of autoimmune encephalitis? The overall prognosis of autoimmune encephalitis is still good, but a good overall prognosis does not mean that every child will maintain good intelligence, exercise and learning ability after treatment.

This disease is a disease with a long treatment time and a slow cycle.

Some patients will have sequelae such as mental movement disorder and epileptic seizures.
The overall treatment time may be several months or several years.

The fatality rate of patients with severe autoimmune encephalitis is about 3%-10%, and some patients will relapse or have symptoms worse.

Therefore, our clinical doctors must pay attention to it, and our parents and friends must also know that there is such a disease.
In this way, my popular science will not be done in vain.

 The responsibility of a doctor is not only to treat diseases, because no matter how capable a doctor is, there is a limit to the number of patients he can directly serve.

Only when the medical knowledge of the general public is improved can the occurrence of diseases be prevented, or detours in the diagnosis and treatment of diseases can be avoided, and the harm caused by diseases can be reduced.

 In the struggle between humans and disease, omnipotent humans seem to have the upper hand.

But in the long river of history, human beings are small, while diseases are unimaginably powerful.
If we look back and explore the footsteps of history, we should recognize this view: medicine or doctors are just born from human beings.
In the process of dying, it is nothing more than the existence of slowing down time.

 References: [1] "Expert Consensus on Diagnosis and Treatment of Autoimmune Encephalitis in China" Pu Chuanqiang, Cui Liying, Jia Jianping [2] "Autoimmune Encephalitis Related Etiology and Pathogenic Mechanism" Ma Jiannan Jiang Li