Clinical approach to the diagnosis and successful management of anti-NMDA receptor encephalitis when antibody testing is not possible

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a multistage illness that progresses from psychosis, memory deficits, seizures and language disintegration to a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. While the disorder predominantly affects children and young adults, and occurs with or without tumour association, the presence of a tumour (usually an ovarian teratoma) is dependent on the age, sex and ethnicity.Teratomas present more frequently in women older than 18 years, and are more predominant in black women than Caucasians. Here we present the case of a patient with probable anti-NMDA receptor encephalitis. She was subsequently found to have a mature teratoma of the ovary (dermoid cyst). Despite immune-modulated therapy, surgery was eventually performed to remove the cyst. This was met with a good clinical recovery.

Anti-NMDA receptor encephalitis with initial negative markers: diagnostic and therapeutic challenges of a refractory case with 9-month-long follow-up

“…The patient, however, presented in our report tested negative for COVID-19 using real-time PCR assays on multiple occasions throughout her hospital course. Additionally, to our knowledge, only two recent case reports had no abnormalities on CSF analysis, though specific anti-NMDA antibody testing was only performed in one case and was positive the first time 27 28…”

Brain anomalies in early psychosis: From secondary to primary psychosis

“…Several case reports have been found to involve midbrain or pontine regions in secondary psychosis. Isolated pontine lesions were observed in a young woman with anti-NMDAR encephalitis on an ovarian teratoma, and who presented with agitated and bizarre behavior suggestive of catatonic symptoms (Ramlackhansingh et al 2019). In another case, psychosis with catatonic features was found in an adolescent with a history of treatment for a midbrain pilocytic astrocytoma.…”