Case report of anti-NMDA receptor encephalitis in a 24-year-old female: an uncommon presentation.
Autoimmune encephalitis
Confusion
Neurology
Psychosis
Journal
The Egyptian journal of neurology, psychiatry and neurosurgery
ISSN: 1110-1083
Titre abrégé: Egypt J Neurol Psychiatr Neurosurg
Pays: England
ID NLM: 0043617
Informations de publication
Date de publication:
2022
2022
Historique:
received:
10
02
2022
accepted:
06
06
2022
entrez:
28
6
2022
pubmed:
29
6
2022
medline:
29
6
2022
Statut:
ppublish
Résumé
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis. Due to the variability of the initial symptoms, anti-NMDAR encephalitis is not only underdiagnosed but also can be misdiagnosed as viral encephalitis or other pathologies. The origin of this disease is often paraneoplastic. Anti-NMDAR encephalitis preferentially affects children and young adults, and it has a male/female ratio of 1/4. In case of clinical suspicion, electroencephalogram and brain magnetic resonance imaging are useful, but lumbar puncture for cerebrospinal fluid analysis is used to confirm the diagnosis. Treatment for this disease includes immunosuppression and tumour resection when indicated. We report the case of a 24-year-old female admitted to the emergency room following the onset of acute confusion. Due to the rapid deterioration of consciousness, swallowing disorders, respiratory failure and severe bradycardia the patient was intubated. On day 23 after presentation, brain magnetic resonance suggested autoimmune limbic encephalitis. Cerebrospinal fluid results were positive for anti-NMDA antibodies. After IV methylprednisolone and plasmapheresis and a second line therapy with corticosteroid and mycophenolic acid, the patient's clinical condition gradually improved. Anti-NMDAR encephalitis typically occurs in young patients with no history of acute psychiatric symptoms. The possibility of this pathology should be taken into account before diagnosing a patient with a psychiatric illness.
Sections du résumé
Background
UNASSIGNED
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis. Due to the variability of the initial symptoms, anti-NMDAR encephalitis is not only underdiagnosed but also can be misdiagnosed as viral encephalitis or other pathologies. The origin of this disease is often paraneoplastic. Anti-NMDAR encephalitis preferentially affects children and young adults, and it has a male/female ratio of 1/4. In case of clinical suspicion, electroencephalogram and brain magnetic resonance imaging are useful, but lumbar puncture for cerebrospinal fluid analysis is used to confirm the diagnosis. Treatment for this disease includes immunosuppression and tumour resection when indicated.
Case presentation
UNASSIGNED
We report the case of a 24-year-old female admitted to the emergency room following the onset of acute confusion. Due to the rapid deterioration of consciousness, swallowing disorders, respiratory failure and severe bradycardia the patient was intubated. On day 23 after presentation, brain magnetic resonance suggested autoimmune limbic encephalitis. Cerebrospinal fluid results were positive for anti-NMDA antibodies. After IV methylprednisolone and plasmapheresis and a second line therapy with corticosteroid and mycophenolic acid, the patient's clinical condition gradually improved.
Conclusions
UNASSIGNED
Anti-NMDAR encephalitis typically occurs in young patients with no history of acute psychiatric symptoms. The possibility of this pathology should be taken into account before diagnosing a patient with a psychiatric illness.
Identifiants
pubmed: 35761962
doi: 10.1186/s41983-022-00512-7
pii: 512
pmc: PMC9219394
doi:
Types de publication
Case Reports
Langues
eng
Pagination
79Informations de copyright
© The Author(s) 2022.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
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