| Background and purposes:Anti-N-methyl-D-aspartate receptor(N-Methyl-D-Aspartate receptor,NMDAR)encephalitis is one of the most common types of autoimmune encephalitis.The disease is acute or subacute onset,the clinical manifestations are mental and behavioral abnormalities,cognitive impairment,seizures and near-memory decline.However,this encephalitis symptom is often preceded by prodromal symptoms(including fever,headache,nausea,vomiting,cough,gastrointestinal discomfort and diarrhoea,etc).At present,little is known about the symptoms of prodromal stage,especially the characteristics of prodromal headache.With the exception of a few reported cases,there is no study on the exact relationship between prodromal headache and anti-NMDAR encephalitis.In this study,the data of prodromal headache in patients with anti-NMDAR encephalitis were collected and sorted out in detail,and the manifestations of prodromal headache in patients with anti-NMDAR encephalitis were analyzed.The general data,clinical manifestations and imaging examination of patients with and without prodromal headache in anti-NMDAR encephalitis were compared,and the characteristics of prodromal headache in patients with anti-NMDAR encephalitis were analyzed.Methods:A total of 89 patients with autoimmune encephalitis diagnosed in the first affiliated Hospital of Zhengzhou University from January 1,2017 to June 1,2018 were prospectively collected.Among them,42 cases of anti-NMDAR encephalitis and 5 cases of adolescents under 14 years of age(because we could not obtain their detailed prodromal headache information)were excluded from this study.Finally,37 cases of anti-NMDAR encephalitis were included.These patients with anti-NMDAR encephalitis were divided into two groups according to the presence or absence of prodromal headache: prodromal headache group(n=28)and non-prodromal headache group(n=9).The data of patients with prodromal headache were collected and sorted out in detail.The characteristics of prodromal headache were analyzed.The relationship between the severity of prodromal headache and abnormal head magnetic resonance imaging(MRI),antibody titer and modified Rankin scale score was analyzed.Was there a difference between the headache group and the non-prodromal headache group in age,sex,clinical symptoms(fever,epilepsy,mental symptoms,cognitive impairment and disturbance of consciousness),cerebrospinal fluid(leukocyte and protein quantification),abnormal cranial MRI,history of migraine and modified Rankin scale score.Results:This study collected a total of 89 patients of autoimmune encephalitis.31 patients(34.8%)had prodromal headache,including 28 anti-NMDAR encephalitis,2 anti-leucine-rich glioma-inactivated 1 antibody-associated encephalitis,and anti-gamma-aminobutyric acid-B receptor antibody.There were 28 cases of headache,26 cases of fever,18 cases of nausea,6 cases of fear of sound,5 cases of vomiting and 2 cases of photophobia in the prodromal stage of anti-NMDAR encephalitis.1.Characteristics of headache in 28 patients with anti-NMDAR encephalitis with prodromal headacheThere were 18 females(64%)and 10 males(35%)with an average age of 29 years old in 28 anti-NMDAR encephalitis patients with prodromal headache.About 50%(14/28)of the patients had pain in the frontal lobe and 43%(12/28)in the temporal lobe.About 64%(18/28)of the patients had pulsating pain and 68%(19/28)had moderate pain(visual analogue scale was 4-7).About 86%(24/28)of the patients had fever and 18%(5/28)of the patients had vomiting.Eighty-two percent(23 to 28)of the patients had a prodromal headache attack lasting within 21 days(an average of 5.5 days)and were usually able to relieve themselves or take some simple analgesics(such as tramadol tablets,Ibuprofen sustained-release capsules,etc.)prior to the onset of encephalitis symptoms were relieved.In 18%(5/28)of the patients,the headache lasted more than 21 days,the headache symptoms gradually deteriorated and encephalitis symptoms occurred,which could be improved after immunosuppressive therapy and / or intravenous gamma globulin treatment.2.Comparison of prodromal headache group and non-prodromal headache groupDuring the prodromal period,86%(24/28)of the patients in the headache group had fever,and 22%(2/9)of the patients in the non-headache group had fever.The comparison between the two groups was statistically significant(P<0.001),suggesting that patients with headache at the prodromal stage of anti-NMDAR encephalitis were more likely to develop fever than those without headache.There were 10 males and 18 females in the prodromal headache group,27 cases of mental and behavioral abnormalities,26 cases of decreased consciousness,23 cases of epileptic seizures,18 cases of abnormal cranial magnetic resonance imaging,8 cases of cognitive impairment,and 4 cases of migraine history.In the non-prodromal headache group,there were 5 males and 4 females,8 patients with mental and behavioral abnormalities,8 patients with cognitive impairment,7 patients with decreased consciousness,6 patients with epileptic seizures,2 patients with abnormal cranial magnetic resonance imaging(MRI),and no history of migraine.There was no significant difference between the two groups(P >0.05).It is suggested that there is no significant difference in anti-NMDAR encephalitis between the prodromal headache group and the non-prodromal headache group in age,sex,clinical symptoms(including epileptic seizures,mental and behavioral abnormalities,cognitive impairment,decreased consciousness),cerebrospinal fluid(white blood cells,protein quantity),abnormal MRI of head,history of migraine and mRS score.Conclusions:1.Headache is the most common symptom in the prodromal stage of anti-NMDAR encephalitis.2.Most of the prodromal headaches against NMDAR encephalitis are located in the temporal lobe and frontal lobe,showing pulsating,moderate pain,a few with vomiting,and some of them can be relieved by themselves.3.Prodromal headache is of great significance in the early diagnosis of anti-NMDAR encephalitis. |
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