Autoimmune encephalitis is a type of encephalitis mediated by autoimmune mechanisms. It can occur in children, adolescents and adults. The clinical manifestations include abnormal mental and behavioral conditions, epileptic seizures, memory dysfunction, speech disorders, movement disorders, coma, autonomic nerve dysfunction, etc. Its occurrence is related to anti-neural antibodies, and common triggers include tumors and infections.
Here is a case of sudden convulsions leading to coma. The patient is a 44-year-old male who was admitted to the hospital on July 8, 2019. Eleven days ago, he developed a fever without any obvious cause, with the highest body temperature reaching 39.0℃, accompanied by pain in both sides of the head and temporal region. There was no nausea or vomiting. He then received anti-infection treatment at a local clinic, but there was no improvement. Four days ago, during a visit to a local hospital, a sudden consciousness disorder occurred, accompanied by convulsions. The symptoms were tilting the head back, deviation of the corners of the mouth, and stiffness of the limbs, which lasted for 10 seconds. The symptoms could be relieved after taking medication (sodium valproate), with an attack occurring approximately every 8 hours. A head CT scan showed no obvious abnormalities. After a cerebrospinal fluid examination, the diagnosis was "meningitis". After anti-infection and anti-viral treatment, there was no improvement.
We decided to have him start hyperbaric oxygen therapy. After combining it with oxygen therapy, the effect was obvious. The patient began hyperbaric oxygen therapy on July 18th, and the treatment plan was 2.2ATA(primary oxygen supply). On July 29th, after 10 sessions of hyperbaric oxygen therapy, the patient's consciousness improved. They could find sounds when called and their limbs could move independently without convulsions. After 30 sessions of hyperbaric oxygen therapy, the patient's consciousness gradually became clear. Currently, the patient is conscious, can answer questions accurately, and can move their limbs freely. Their memory, orientation, and calculation abilities have all recovered.
The mechanism of hyperbaric oxygen action
Hyperbaric oxygen can increase blood oxygen content and partial pressure of oxygen, expand the range of blood oxygen diffusion, and thereby improve oxygen supply to the brain.
2. Enhance the scavenging function of oxygen free radicals and reduce reperfusion injury to brain tissue.
3. Hyperbaric oxygen can enhance ATPase activity, ensure the energy supply to brain nerve cells, and improve cellular energy metabolism.
4. Enhance cellular immune function and improve the swallowing function of T cells.
Special note:
At present, there is no specific treatment for autoimmune encephalitis. Hyperbaric oxygen therapy is indeed effective for consciousness disorders. Compared with viral encephalitis, both are brain function disorders, but the causes are different. The treatment plan can refer to that for viral encephalitis, which requires a longer course of treatment. Hyperbaric oxygen is beneficial for the recovery of brain function.
