关键词: 硬膜外脂肪增多症； 抗NMDAR脑炎； 糖皮质激素

Abstract: Objective To investigate clinical characteristics and treatment of spinal epidural lipomatosis (SEL) caused by glucocorticoids in the treatment of anti-N-methyl-D- aspartate receptor (NMDAR) encephalitis. Methods The clinical data of one child diagnosed as anti-NMDAR encephalitis in May 2018 were retrospectively analyzed. A literature search was conducted at Wanfang database and PubMed, and the relevant literature were reviewed. Results The 8 -year-old girl was hospitalized for "involuntary movement of the right limb, seizure and abnormal mental behavior". The anti-glutamate receptor antibody IgG of CSF was positive with a titer of 1 :32 . Then the diagnose of anti-NMDAR encephalitis was made. She was treated with gamma globulin, glucocorticoid, prednisone, plasma exchange and cyclophosphamide immunotherapy. During the follow-up, abnormal increase of cerebrospinal fluid protein was found. Spinal cord MRI showed spinal epidural lipomatosis. We then stop prednisone by dose tapering and help her lose weight through diet control and exercise. Then the follow-up spinal MRI showed significant improvement. At present, there are 14 English papers published about SEL caused by steroid therapy in the treatment of other childhood diseases, but no report about SEL caused by glucocorticoids in the treatment of children with NMDAR encephalitis. Children with SEL may present back pain, numbness, weakness, abnormal gait, incontinence and acute paralysis and in some cases may present no symptom. Conclusion The use of steroids for treating anti-NMDAR encephalitis may caused SEL, which could be early diagnosed before the clinical symptoms occur and treated by stopping steroids and controlling body weight.

Key words: Spinal epidural lipomatosis; Anti-N-methyl-d-aspartate receptor encephalitis; Glucocorticoid