精神症状で発症し呼吸器管理を要したが予後良好で，卵巣奇形腫を合併した辺縁系脳炎の1例

A Case of Limbic Encephalitis Complicated with Ovarian Teratoma and Respiratory Failure after the Onset of Psychiatric Symptoms, with a Good Prognosis

抄録

　19歳の女性。入院前日より，独語，興奮などが出現し当科に入院した。徐々に昏迷となりその後意識障害が進行し，著明な流涎，多量の発汗，項部硬直，不随意運動，血圧の変動，頻脈なども伴ってきた。呼吸障害も出現し呼吸器管理となった。その後，これらの症状が急速に改善された。頭部MRIでは異常を認めず，髄液所見では単核球の軽度増加のみ認められた。脳波では一時全般性に高振幅徐波が認められた。SPECTでは，広範囲に相対的血流低下が確認された。治癒後，卵巣奇形腫の存在が確認された。本症例の臨床経過は，「急性可逆性辺縁系脳炎」「若年女性に好発する急性非ヘルペス性脳炎」「抗NMDAR脳炎」の特徴に一致した。

　A 19-year-old woman was admitted to our hospital because of symptoms of agitation and monology. She gradually developed stuporous；this was followed by impaired consciousness with hypersalivation, hyperhidrosis, nuchal rigidity, involuntary movement, fluctuating blood pressure, and tachycardia. She eventually developed respiratory failure. Thereafter, the symptoms rapidly improved. MRI revealed no cerebral abnormalities, and examination of the cerebrospinal fluid indicated only a slight increase in the lymphocyte count. Electroencephalography revealed generalized bursts of high-voltage slow waves. Single-photon emission computed tomography revealed an extensive decrease in the relative blood flow. MRI of the abdomen revealed the presence of an ovarian teratoma. The clinical characteristics in the present case were consistent with those of acute reversible limbic encephalitis, acute juvenile female non-herpetic encephalitis, and anti-NMDAR encephalitis.