Anti-NMDA receptor encephalitis: case report

Anti-NMDA receptor encephalitis is an autoimmune disease characterized by prodromal signs- malaise, fever, headache, followed by rapidly progressive psychiatric symptoms- delusional thoughts, hallucinations, psychosis, agitation, cognitive deterioration, and neurological signs- movement abnormalities, seizures, and autonomic dysfunction. Most commonly young women are affected. Case report: We describe a case of a 21-year-old previously healthy woman who presents with a tingling sensation in the arms and legs. Later she has a generalized tonic-clonic seizure and develops hallucinations. The patient is hospitalized in a psychiatric facility where she experiences episodes of agitation, psychosis, later becomes unresponsive and has another generalized tonic-clonic seizure after which she is transferred to a neurology department. Her vital signs are stable, neurologic examination shows decreased level of consciousness, symmetric pupils, symmetrical limb movements and normal reflexes. Early blood work, CSF analysis and brain MRI shows normal findings. With a high suspicion of autoimmune encephalitis therapy with glucocorticoids and plasma exchange is started. A CSF analysis of autoimmune antibodies is done and confirms the diagnosis of Anti-NMDA receptor encephalitis. Further work-up shows no signs of oncology. After no changes in her status, she receives a five-day course of IVIG. One month after admission head MRI shows hyperintensity in the hippocampus and parahippocampal gyrus region. Her condition gradually stabilizes and after 2 months she is discharged to a rehabilitation facility. The first symptoms are usually psychiatric and, the correct diagnosis is often overlooked. A female patient of reproductive age presenting with new-onset psychiatric symptoms alongside with neurological symptoms (e.g. seizures) and autonomic disturbances should be approached with a high suspicion of anti-NMDA receptor encephalitis.