Anti-N-Methyl-d-Aspartate Receptor Encephalitis

Lim, Sian Yik; Panikkath, Ragesh; Mankongpaisarnrung, Charoen; Islam, Ebtesam; Mulkey, Zachary; Nugent, Kenneth

doi:10.1097/maj.0b013e3182760e3b

Cited by 7 publications

(3 citation statements)

References 4 publications

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“…Autonomic instability, such as intermittent episodes of tachycardia and bradycardia has previously been described in anti-NMDA receptor encephalitis [ 2 , 5 , 9 – 11 , 13 , 16 , 17 ], but severe bradycardia or asystole necessitating cardiopulmonary resuscitation [ 9 ] or pacemaker placement [ 5 , 9 – 12 ] is rare. In a series of 100 patients with anti-NMDA receptor encephalitis [ 5 ], 37 patients had cardiac arrhythmias, 7 patients had prolonged pauses, and 4 patients required pacemakers [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patient also had increased intracranial pressure (ICP). To the best of our knowledge, there are only 4 articles, including 2 case reports [ 12 , 13 ], that have reported elevated ICPs in patients with anti-NMDA receptor encephalitis [ 7 , 12 – 14 ]. However, one of these articles, which is a retrospective study on 35 cases of severe anti-NMDA receptor encephalitis, indicates that up to 42.86% of the patients had elevated intracranial pressures [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Severe Anti-N-Methyl D-Aspartate (Anti-NMDA) Receptor Encephalitis with Refractory Autonomic Instability and Elevated Intracranial Pressure

et al. 2018

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Patient: Female, 21Final Diagnosis: Anti-NMDA receptor encephalitisSymptoms: Altered mental status • headacheMedication: Intravenous immunoglobulin • methylprednisolone • cyclophosphamide • rituximabClinical Procedure: Cardiac pacemaker • bilateral salpingo-oophorectomySpecialty: Neurology • Critical CareObjective:Unusual clinical courseBackground:Anti-N-methyl D-Aspartate (anti-NMDA) receptor encephalitis is a rare autoimmune panencephalitis that typically presents with acute psychiatric disturbances and neurological deficits. Anti-NMDA receptor encephalitis is associated with certain tumors, most commonly ovarian teratomas. First-line therapy typically involves immunotherapy and tumor resection, if present, with up to 53% of patients experiencing improvement within 4 weeks. Cardiac arrhythmias and increased intracranial pressure have been reported in anti-NMDA receptor encephalitis, but these complications have usually been self-limited.Case Report:We report the case of a previously healthy, obese 21-year-old female who presented with acute encephalopathy. Her psychiatric and neurological function rapidly deteriorated, warranting intubation and mechanical ventilation. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was elevated and a lumbar drain was placed. Infectious disease work-up was negative and anti-NMDA receptor antibodies were present in the CSF and serum. Initial treatment included intravenous immunoglobulin (IVIG) therapy, plasmapheresis, methylprednisolone, and bilateral salpingoophorectomy, without clinical improvement. Second-line immunotherapy with cyclophosphamide and rituximab was then administered. The patient also developed intermittent episodes of severe bradycardia and asystole that remained refractory to treatment and required placement of a permanent cardiac pacemaker.Conclusions:Anti-NMDA receptor encephalitis presents with rapidly progressive psychiatric and neurologic dysfunction and can develop a severe and prolonged course with limited response to treatment. Patients can develop severe autonomic dysfunction with bradycardia and asystole that may require placement of permanent cardiac pacemakers. Elevated intracranial pressure may also be associated with anti-NMDA receptor encephalitis, and might contribute to the autonomic instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Severe Anti-N-Methyl D-Aspartate (Anti-NMDA) Receptor Encephalitis with Refractory Autonomic Instability and Elevated Intracranial Pressure

et al. 2018

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“…A cited reference search (Google Scholar) however identified two reports describing meningitis as a presenting feature. 4,5 and was the Lim et al paper really consistent with meningitis?…”

Section: Think You Can Omit Ref 4 -It Doesn't Apppear Very Relevantmentioning

confidence: 99%

060 Fulminant meningitis as a presenting feature of anti-NMDA receptor encephalitis

Stavrou

Yeo

Slater

et al. 2019

J Neurol Neurosurg Psychiatry

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Anti-NMDA receptor encephalitis is a well-recognised immunotherapy-responsive condition which often occurs as a paraneoplastic phenomenon. A typical presentation is in a young individual with a viral-like prodrome followed by the development of severe psychiatric symptoms, memory loss, seizures, reduced consciousness and sometimes orofacial dyskinesias, and progression to autonomic and respiratory instability. Fulminant meningitis is a very rare presenting feature of anti-NMDA receptor encephalitis with our literature search only revealing one other reported case.We present a case of a 33-year old Caucasian woman who initially presented with lymphocytic meningitis but subsequently developed clinical and investigative features consistent with anti-NMDA receptor encephalitis. Through this case, we aim to present and discuss possible mechanisms1–3underlying this atypical presentation and to highlight frank meningitis as an atypical presenting feature of anti-NMDA-receptor encephalitis. Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative micro-organism and there is rapid development of an encephalitic phenotype. A multidisciplinary approach is required to address the neurological, gynaecological, oncological, and neuropsychiatric aspects of this challenging and incompletely understood disorder.ReferencesBektaş Ö, et al.Neuropediatrics2014;45(6):396–401Irani SR, et al.Brain2010;133(Pt 6):1655–67Dalmau J, et al.Lancet Neurol2008;7(12):1091–8

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Catatonia in N-methyl-d-aspartate receptor antibody encephalitis: Phenomenological characteristics from a systematic review of case reports

Serra-Mestres

Villagrasa²,

Thacker³

et al. 2020

General Hospital Psychiatry

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Anti-N-Methyl-d-Aspartate Receptor Encephalitis

Cited by 7 publications

References 4 publications

A Case of Severe Anti-N-Methyl D-Aspartate (Anti-NMDA) Receptor Encephalitis with Refractory Autonomic Instability and Elevated Intracranial Pressure

A Case of Severe Anti-N-Methyl D-Aspartate (Anti-NMDA) Receptor Encephalitis with Refractory Autonomic Instability and Elevated Intracranial Pressure

060 Fulminant meningitis as a presenting feature of anti-NMDA receptor encephalitis

Catatonia in N-methyl-d-aspartate receptor antibody encephalitis: Phenomenological characteristics from a systematic review of case reports

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