Anti‐NMDAR encephalitis: case report and diagnostic issues

Abstract

Case: A 20-year-old woman developed acute psychotic symptoms and altered level of consciousness. She presented with neck stiffness, tremulous arms, facial dyskinesia, and distension of the lower abdomen. Pelvic magnetic resonance imaging showed bilateral ovarian teratomas. Anti-N-methyl-D-aspartate receptor antibodies were detected in her cerebrospinal fluid.Outcome: Resection of the tumors and immunotherapy were carried out. She gradually recovered and was discharged with few neurological deficits on the 105th day of hospitalization. Conclusion:Our survey of 63 previous reports describing 92 cases revealed that 21.7% of the patients were sent to emergency departments and 59.8% of the patients were managed in intensive care units. Emergency physicians and intensivists should be aware of this disorder, as they may encounter undiagnosed disorders in patients with epileptic attacks, acute psychotic signs, dyskinesia, or hypoventilation in the course of the illness.

The Brain on Fire: A Case Study on Anti-NMDA Receptor Encephalitis

“…This includes corticosteroid therapy agents such as methylpredniso-lone, dexamethasone and prednisolone to reduce inflammation in the brain. Concurrent treatment with H2 receptor antagonists such as ranitidine or pantoprazole are given to prevent steroid induced mucosal damage (Omura et al, 2015). In addition, immunotherapies like intravenous immunoglobulin (IVIg) are administered to decrease inflammation of the meninges and inhibit the binding of anti-NMDA antibodies.…”

“…A notable clinical manifestation of anti-NMDA receptor encephalitis involves a triad of specific features that present as epilepsy, dyskinesia and psychiatric symptoms (Omura et al, 2015). A list of general clinical features such as focal neurological signs, psychiatric signs and autonomic instability noted in various documented cases to date are listed in the Table 1.…”