Anti-NMDA receptor encephalitis: a case study and illness overview

Ford, Brian; McDonald, Alex J.; Srinivasan, Shilpa

doi:10.7573/dic.212589

Cited by 27 publications

(59 citation statements)

References 32 publications

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“…Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders; hence, it is so frequent for these patients to be initially seen and evaluated as new-onset psychosis. 1 In our case, schizophrenia was ruled out as she did not have prodromal symptoms such as avolition or social withdrawal, in addition to negative family history of mental illness and presence of insight into her unusual thoughts. In light of her recent travel history and acute deterioration, substance-induced psychosis was also considered; however, her symptoms worsened even in the absence of substance use which makes this differential diagnosis very much least likely.…”

Section: Discussionmentioning

confidence: 85%

“…Anti- N -methyl-D-aspartate receptor (anti-NMDAR) encephalitis is now considered the most common cause of autoimmune encephalitis after acute demyelinating encephalitis and 80% of patients are women. 1 The autoimmune process was first described in 2007 when Dalmau et al 2 portrayed the existence of autoantibodies to NR1-NR2 heteromers in 11 women with ovarian teratoma together with neuropsychiatric symptoms. Since then, more than 1000 cases have been reported and the exact incidence of anti-NMDAR encephalitis is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Khoodoruth

Alshawwaf

2020

SAGE Open Medical Case Reports

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Anti- N-methyl-D-aspartate receptor encephalitis is a life-threatening medical emergency that can be clinically misperceived as Hashimoto’s encephalopathy. We present a case of anti- N-methyl-D-aspartate receptor encephalitis in an otherwise healthy young female with subclinical hypothyroidism without an associated ovarian teratoma. She was first misdiagnosed as Hashimoto’s encephalopathy due to delirium and behavioral changes, seizures, psychosis, and increased amount of thyroid peroxidase and thyroglobulin antibodies in serum. Final diagnosis was established by third week following presentation with the detection of anti- N-methyl-D-aspartate receptor antibodies in her cerebrospinal fluid. After treatment with intravenous immunoglobulin, methylprednisolone, and amisulpride, she recovered significantly with minimal sequelae at 3-week follow-up.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Khoodoruth

Alshawwaf

2020

SAGE Open Medical Case Reports

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“…Serology confirmed the presence of anti-NMDAR antibodies following which she was administered IVIG, IV corticosteroids, plasmapheresis, and rituximab. The patient was eventually discharged after 130 days with continuous improvement on serial follow-ups [8].…”

Section: Vol 6 | Issue 5 | May 2020mentioning

confidence: 94%

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Presenting as Postpartum Psychosis: A Case Report

Roy¹,

Karia²,

Shah³

et al. 2020

IJCR

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nti-N-methyl-d-aspartate (NMDA) receptor encephalitis was first described in 2007 when 12 patients presenting with prominent neuropsychiatric symptoms were confirmed to have antibodies to the NMDA receptors in their serum or cerebrospinal fluid (CSF) [1]. Patients with anti-NMDA receptor encephalitis have been reported to have high rates of psychiatric symptoms and clinicians may be unaware of diverse presentations that unfold in this disorder [2]. Acute psychosis in anti-NMDA receptor encephalitis is associated with serum and CSF IgG antibody titers against the NR1a subunit of the receptor. However, antibodies against different antigens (e.g., the NR2a and NR2b subunits) have been described in cases of limbic encephalitis, systemic lupus erythematosus (SLE), and psychiatric symptoms may not be exclusive to the NR1a subunit [3].Potential causes for the behavior, learning, and memory difficulties in anti-NMDA receptor encephalitis have been postulated to be due to reversible predominant frontotemporal atrophy, an area in which NMDA receptors are present in high density; therefore, suggesting an immunological cause to the atrophy [4]. Here, we report the case of a 24-year-old female who presented to the hospital with symptoms suggestive of postpartum psychosis but further investigations revealed her to be positive for anti-NMDA receptor autoantibodies. CASE REPORTA 24-year-old Hindi speaking Muslim female educated until the 5 th standard, married and a homemaker, resident of Mumbai and

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“…Fase klinis ensefalitis anti -NMDAR terbagi menjadi 4 gejala (Gambar 3) yaitu: 13 (1) Gejala prodromal. 70% dari pasien ensefalitis anti NMDAR mengalami fase prodromal.…”

Section: Laporan Kasusunclassified

Plasmafaresis pada Pasien Status Epileptikus Akibat Ensefalitis Anti-NMDAR di Unit Perawatan Intensif

Vinca¹,

Kestriani²,

Budipratama³

2020

jap

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Sejak tahun 2007 penyebab lain ensefalitis diketahui adalah autoimmun selain virus sebagai penyebab terbanyak (69%) dengan angka kematian di dunia 8-18,45%. Ensefalitis anti-NMDAR adalah ensefalitis autoimun akibat reaksi antibodi terhadap antigen membran ekstraseluler, subunit NR1, yaitu reseptor glutamat NMDA di sinapsis susunan saraf pusat. Kasus ensefalitis NMDAR sangat jarang dijumpai, berdasarkan penelitian yang teridentifikasi hanya 1% pasien usia 18-35 tahun yang dirawat di Unit Perawatan Intensif (UPI), namun dengan penatalaksanaan yang tepat dapat meningkatkan prognosis pasien. Pasien laki-laki, usia 36 tahun dikonsulkan ke UPI RSHS setelah 10 hari rawatan di Neuro High Care (NHC) pada bulan Agustus 2019 dengan penurunan kesadaran disertai riwayat kejang berulang dengan diagnosis ensefalitis anti-NMDAR. Kombinasi obat anti-viral, anti-epilepsi, dan metilprednisolon yang diberikan sebelumnya di ruangan tidak memberikan perbaikan klinis bermakna. Selama perawatan di UPI pasien diberikan terapi plasmafaresis dan menunjukkan perbaikan secara signifikan. Bangkitan kejang berulang dapat berupa kejang parsial, kejang generalisata dan status epileptikus. Manifestasi kejang diduga terjadi karena terbentuknya antibodi yang menyerang reseptor glutamat NMDA dengan target utama NR1. The American Society for Apheresis merekomendasikan plasmaferesis sebagai pilihan terapi utama. Simpulan, terapi plasmafaresis dalam tata laksana kasus ensefalitis anti-NMDAR merupakan pilihan tepat karena terbukti efektif dan efisien dalam perbaikan klinis pasien melalui mekanisme penurunan titer antibodi terhadap reseptor NMDA.

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Anti-NMDA receptor encephalitis: a case study and illness overview

Cited by 27 publications

References 32 publications

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Presenting as Postpartum Psychosis: A Case Report

Plasmafaresis pada Pasien Status Epileptikus Akibat Ensefalitis Anti-NMDAR di Unit Perawatan Intensif

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