Case Of anti-NMDA Receptor Encephalitis Research Articles

PS-R03-11: ANTI-NMDA RECEPTOR ENCEPHALITIS: SEIZURES AND PSYCHOSIS: A CASE REPORT ABOUT 18-YEAR OLD ADMITTED AT ARMMC

Introduction: Anti-NMDA receptor encephalitis is one of many autoimmune diseases that need further recognization. Its signs and symptoms are indefinite and there is no specific pathognomic sign that can be use to properly diagnosed the disease immediately. Therefore more often these patients are prone to misdiagnosis. Many reports claimed that it is directly associated with ovarian teratomas in women though in some reports it can also be seen in males. This case helps in further recognizing anti-NMDA receptor encephalitis especially in our country where there are only few cases reported. Case: The case presented is about an 18-year old female from Mindoro Philippines who was previously well and had sudden changes in behavior with seizures episodes. Patient had consult at their local hospital where she was being treated as a case of viral meningitis but apparently no improvement was noted and subsequently transferred to a tertiary hospital in Metro Manila for further evaluation and management. During her hospital stay at Amang Rodriguez Memorial Medical Center patient presented as seizures with abnormal psychiatric features where she was eventually suspected to have anti-NMDA (anti-N-methyl-D-aspartate) receptor encephalitis but further testing was done initially to rule out other neurologic diseases. Almost all laboratories and radiologic tests turn out to be normal hence a video electroencephalogram (EEG) was requested and result was that the patient is suggestive to have the said disease. Definitive test for anti-NMDA receptor encephalitis was done which turned out positive. The patient was then treated as a case of anti-NMDA receptor encephalitis and manage accordingly. Improvement was noted and the patient was then discharged subsequently. Conclusion: There may be increasing cases of anti-NMDA receptor encephalitis worldwide further research must still be done to be able to understand its features diagnose and manage it appropriately. And since it is more common in young adult females anti-NMDA receptor encephalitis must be suspected and be taken into consideration when there is a patient who presented with sudden changes in behavior with psychosis and seizures.

Anti-NMDA Receptor Encephalitis: Retrospective Analysis of 15 Cases, Literature Review, and Implications for Gynecologists.

Background Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare form of autoimmune encephalitis caused by anti-NMDA receptor antibodies. This disease mainly affects women of childbearing age and is commonly associated with ovarian teratoma. However, the relationship between anti-NMDA receptor encephalitis and ovarian teratoma and the role of anti-NMDA receptor antibody in the relationship remain unclear. Objectives This study aimed to describe 15 cases of anti-NMDA receptor encephalitis (5 with ovarian teratoma), review literature, and reinforce the gynecologist's knowledge of this disorder. Methods Clinical data of 15 patients from January 2015 to December 2020 admitted to The Second Hospital of Hebei Medical University were collected and analyzed. The diagnosis of anti-NMDA receptor encephalitis was based on the presence of anti-NMDA receptor antibodies in cerebrospinal fluid (CSF) and/or serum. Laparoscopic teratoma removal was performed in patients with ovarian teratoma. All patients had received immunotherapy. In addition, a review of the literature was performed to reinforce the gynecologist's knowledge of this disorder. Results A total of 15 patients with anti-NMDA receptor encephalitis were screened, of whom 5 patients were confirmed with ovarian teratoma by pathology. The most common symptoms of anti-NMDAR encephalitis with teratoma are fever (5/5, 100%), seizure (5/5, 100%), mental and behavioral disorders (4/5, 80%), and decreased consciousness (4/5, 80%). Conversely, the most common symptoms of patients without teratoma were neuropsychiatric symptoms, including headache (6/10, 60%) and mental and behavioral disorders (7/10, 70%). All patients underwent immunotherapy, including steroids, intravenous immunoglobulin (IVIG), plasma exchange, and cyclophosphamide, and 4 out of 5 patients with ovarian teratomas underwent surgical treatment. All patients had a good outcome after systemic, surgical, and immunotherapy treatment. No patient who underwent surgical treatment developed a recurrence. Conversely, 2 of 10 patients without teratoma developed an anti-NMDA receptor encephalitis recurrence. Conclusions Patients with anti-NMDA encephalitis show severe mental and neurological symptoms. Resection of teratoma is beneficial to the relief or disappearance of symptoms and has a good prognosis. This disorder should be fully recognized by gynecologists, who play an important role in diagnosis and treatment.

Clinical case of anti-NMDA receptor encephalitis associated with new coronaviral infection (COVID-19)

During the outbreak of coronavirus disease 2019 (COVID-19) clinicians are increasingly involved in the observation of possible neurological complications due to the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Some cases of encephalitis following COVID‐19 pandemic have been reported in literature that can mean possible damage to the central nervous system related to the SARS-CoV-2 infection. Early on, this was thought to be due to the direct effects of the virus itself, but the possibility of immune system mechanisms being implicated was gradually raised in scientific literature. The reports of anti‐NMDA receptor encephalitis among patients with COVID‐19 at different ages may be signs of this condition. We report the case of 16-year teenager with concomitant Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) encephalitis and COVID‐19. This clinical case brings arguments on the possible relationship between SARS-CoV-2 infection and autoimmune encephalitis.

A case of anti-NMDA receptor encephalitis with thymoma

To explore the clinical characteristics, imaging examination, test characteristics, diagnostic ideas and treatment plans of anti-N-methyl-D aspartate receptor encephalitis, so as to better understand anti-NMAD receptor encephalitis. Methods: To analyze the diagnosis and treatment process of a case of anti-NMAD receptor encephalitis with thymoma admitted to the Department of Neurology of our hospital on May 31, 2021, and review the relevant literature. Results: In this article, the anti-NMAD encephalitis patients with pons as the main affected site also had thymoma, their disease progressed rapidly, clinical manifestations, imaging examinations were not typical, the effect of hormone therapy was not good, and the prognosis was poor

2021 American Neuropsychiatric Association Annual Meeting Abstracts

Background: COVID-19 has been linked to neuropsychiatric symptoms, including delirium, depression/anxiety, PTSD, and rarely, severe neuropsychiatric impairment. However, much remains unknown. We present a case of anti-NMDA receptor encephalitis in a patient with concurrent COVID-19 infection. Case History: A 27-year-old male who carried diagnoses of unspecified mood versus psychotic disorder was admitted with atypical psychosis and suicidal ideation. Patient initially presented to primary care with racing thoughts, delusions, depression (PHQ-9517), anxiety (GAD-7510), and new onset cognitive symptoms along with olfactory hallucinations. He endorsed daily suicidal ideations and reported using two cellphones to block suicidal waves and enhance his memory. He was admitted to inpatient psychiatry where he exhibited disorganized behavior and paranoid delusions, and reported visual hallucinations. Initial workup of EEG, brain MRI, and TSH were unremarkable. Two months after admission, he developed sore throat and fever and tested positive for COVID-19. Patient developed streaky opacites on chest X-ray, was transferred to the ICU, and intubated due to agitation. Once extubated, he experienced repeated epileptic seizures despite multiple antiepileptics, and lumbar puncture ultimately revealed anti-NMDA receptor antibodies. Symptoms slowly improved with plasmapheresis, steroids, and Rituximab. Conclusions: Case reports suggest that some patients may present with neuropsychiatric symptoms or experience neuropsychiatric sequelae following COVID-19 infection. Infection itself can precipitate an autoimmune encephalitis and may also cause neurological damage which can unmask other neuropsychiatric conditions. This case highlights that research is needed to understand the intersection between COVID-19 infection and mechanisms implicated in other neuropsychiatric disorders, including the spectrum of autoimmune encephalitides.

A Rare Case of Anti-NMDA Receptor Encephalitis Associated with an Ovarian Teratoma

Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a syndrome of psychiatric symptoms and neurologic sequelae that is commonly associated with an ovarian teratoma. The antagonism of cerebral NMDA receptors disrupts normal brain activity causing acute onset psychological disturbances including mania, psychosis, or anxiety. Due to the rarity of the condition, diagnosis may be delayed as other common disorders such as primary psychiatric disorders or infectious encephalitis are ruled out. With rapid diagnosis and management, including resection of the tumor and immunotherapy, positive outcomes may be achieved. We present the case of a 25-year-old female with neuropsychiatric manifestations and an ovarian teratoma who was subsequently diagnosed with anti-NMDA-receptor encephalitis.

Autoimmune Encephalitis in Latin America: A Critical Review

Autoimmune encephalitis is an increasingly recognized cause of encephalitis. The majority of case series report patients residing in developed countries in the northern hemisphere. The epidemiologic features of autoimmune encephalitis in Latin America are still unclear. The aim of the study was to perform a review of the clinical presentation of autoimmune encephalitis in Latin America and compare to world literature. References were identified by an in-depth literature search and selected on the basis of relevance to the topic and authors' judgment. We selected clinical studies and case reports published from 2007 to July, 2020 including patients from Latin American countries. Of the 379 patients included, the majority were cases of anti-NMDA receptor encephalitis (93.14%), followed by anti-VGKC-complex encephalitis (N = 17; 4.48%), anti-GAD encephalitis (N = 9; 2.37%), anti-AMPA receptor encephalitis (N = 1; 0.26%), anti-GABA receptor encephalitis (N = 1; 0. 26%), anti-mGluR5 encephalitis (N = 1; 0. 26%), and anti-mGluR1 encephalitis (N = 1; 0. 26%). Reported cases of Anti-NMDA encephalitis in Latin-America had a very slight female predominance, lower prevalence of associated tumors and a lower incidence of extreme delta brush on electroencephalogram. Autoimmune encephalitis is possibly underdiagnosed in underdeveloped countries. Its outcome after treatment, however, appears to be similarly favorable in Latin American patients as has been reported in developed countries based on available case reports and case series. Regional specificities in the manifestation of autoimmune encephalitis could be related to epidemiologic factors, such as the presence of different triggers and different genetic and immunologic background, that need to be studied by future research.

Anti-NMDA Receptor Encephalitis in a Patient with a History of Autism Spectrum Disorder

Background: Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune syndrome characterized by a well-described constellation of neuropsychiatric symptoms. Its exact pathophysiology is poorly understood, but it is thought to be mediated by autoantibodies against NMDA (N-methyl-D-aspartate)-type glutamate receptors in the central nervous system. There is ongoing literature to suggest that patients with autism spectrum disorder (ASD) have evidence of neuroinflammation—or by definition, encephalitis. Objective: To investigate the link between autism spectrum disorder and autoimmune encephalitides. Methods: We present a case of anti-NMDA receptor encephalitis in a patient with autism spectrum disorder. “OP” is a 16-year-old male with a history of attention-deficit/ hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) who presented with a 3-day history of acute-onset altered mental status, electroencephalogram (EEG)-corroborated seizures, and slurred speech. Laboratory studies were significant for serum- and cerebrospinal fluid (CSF)-positive NMDA antibodies. The child psychiatry consult-liaison service was consulted for significant agitation and behavioral dyscontrol. We recommended 1:1 observation for safety, as well as antipsychotic agents titrated to clinical effect. The patient had a protracted hospital course, but was eventually discharged to an acute rehabilitation facility for continued stabilization and therapy. Conclusion: It remains to be seen if the relation between encephalitis and ASD is uni- or bidirectional, that is: whether children with ASD have a genetic diathesis to developing encephalitides (such as those mediated by the NMDAR), or conversely, if deranged or inflamed neuroreceptor processes are implicated in the development of ASD.

The association of herpes simplex type 1 encephalitis and anti –N methyl D aspartate receptor antibody encephalitis in a case

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis characterized by seizures, psychiatric symptoms, and movement disorder, which may present with an acute or subacute course. It has been reported that the production of anti-NDMA receptor antibodies can be triggered in the course of herpes simplex encephalitis and anti-NMDA receptor encephalitis may occur clinically. It has been reported that 25% of patients with HSV encephalitis have anti-NDMA receptor antibodies and are associated with impaired improvement in cognitive performance. In this article, we present a case of anti-NMDA receptor encephalitis associated with HSV-type 1 encephalitis in a 30-year-old woman and review the literature. After the patient's treatment for HSV encephalitis ended, her psychiatric symptoms such as anxiety, agitation, hallucinations and euphoria persisted and he was diagnosed with anti NMDA receptor antibodies detected in CSF. The patient was transferred to the neurology clinic and intravenous immunoglobulin treatment was started.

Anti NMDA encephalitis presenting with mixed psychiatric symptoms - case report

Anti NMDA receptor encephalitis is an autoimmune reaction against neuronal cell surface antigens. The prevalence of this condition is about 0.6 per lakh. Here, we present the case of an 18-year-old female, who presented with seizures along with both dissociative and psychotic symptoms. Later, she turned out to be a case of Anti-NMDA receptor encephalitis. Anti NMDA receptor encephalitis presents with behavioural, cognitive, psychiatric and neurological symptoms progressing to coma and death if untreated. The patient did not show improvement with first-line therapy like IVIG. Hence, the second-line agent, Rituximab, had to be used. She needed three anti-epileptic drugs for seizure control. There is evidence that delay in treatment can adversely affect the prognosis. There should be increased awareness among psychiatrists and other relevant medical professionals about this under-diagnosed disorder.

A Case of Anti-NMDA Receptor Encephalitis with Full Recovery

A Case of Anti-NMDA Receptor Encephalitis with Full Recovery

Anti-N-methyl-D-aspartate receptor encephalitis associated with a tiny ovarian teratoma diagnosed by exploratory laparoscopy: report of two cases

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is the most common form of paraneoplastic encephalitis that is associated with teratomas. Because removal of the tumor leads to better clinical outcomes, determining the location of teratomas is essential. The authors report two cases of anti-NMDA receptor encephalitis with a small ovarian teratoma that could not be detected by usual imaging. Both cases had the diagnosis confirmed laparoscopically.

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

Abstract Anti-NMDA receptor encephalitis is a rare disease that occurs when antibodies produced by the body’s own immune system attack the N-methyl-d-aspartate (NMDA) receptors in the brain (Dalmau, 2016). For a relatively rare condition, one academic hospital in an urban centre noted four cases of anti-NMDA receptor encephalitis in one single year. Patients develop a multistage condition that progresses from psychosis, memory deficits, seizures, respiratory difficulties, abnormal catatonic movements and language disintegration into a state of unresponsiveness (Dalmau, Lancaster, Hernandez, Rosenfeld and Gordon, 2011). This case study will focus on the pathologies and medical journeys of three female patients diagnosed with anti-N-NMDA receptor encephalitis at this hospital. This paper will discuss the presentations of each of the cases and the individualized nursing care plans developed to address the needs of this patient population. More specifically, it will highlight the importance of ensuring patient and staff safety in the development of these care plans. The need for implementing ongoing evaluations of these nursing care plans to address the developing needs of patients as they proceed through the diverse and complex phases of the condition will also be discussed.

Pediatric anti-NMDA receptor encephalitis with catatonia: treatment with electroconvulsive therapy

BackgroundAnti-NMDA receptor encephalitis, an autoimmune disease associated with antibodies against N-methyl-D-aspartate (NMDA) receptors, is being diagnosed more frequently, especially in children and young adults. Acute neurological and psychiatric manifestations are the common presenting symptoms. Diagnosing anti-NMDA receptor encephalitis is often challenging given the wide range of clinical presentation, and may be further complicated by its overlap of symptoms, brain MRI changes, and CSF findings with other entities affecting the brain. Even though diagnosis can be made by identifying antibodies in immune-mediated encephalitis, the diagnosis may be delayed by weeks to months. Delay in initiation of treatment with immune suppressive therapies is shown to be associated with adverse outcomes. Malignant catatonia is a severe and life-threatening state associated with anti-NMDA receptor encephalitis. It is often inadequately assessed and may not respond to immunosuppressive treatment.Case presentationWe present a confirmed case of anti-NMDA receptor encephalitis in a 16 year old girl who had severe critical neurological and psychiatric manifestations, including malignant catatonia and autonomic instability. Our patient continued to manifest malignant catatonia despite the initiation of prompt, aggressive immune suppressive therapies, including corticosteroids, plasmapheresis, intravenous gammaglobulin and rituximab, as well as treatment with high-dose benzodiazepines. Once electroconvulsive therapy (ECT) began, she had a robust response with resolution of her catatonia. Six weeks after treatment with eight ECT cycles, she had returned to her normal baseline cognitive and motor function.ConclusionsECT was an effective and well-tolerated therapy in our patient, and should be considered for the treatment of children with anti-NMDA receptor encephalitis whose catatonia does not respond to immunosuppression and benzodiazepines.

Refining the psychiatric syndrome of anti-N-methyl-d-aspartate receptor encephalitis.

To review the psychiatric symptoms of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, in an attempt to differentiate the presentation from a primary psychiatric disorder. A systematic literature review of PubMed and EMBASE of all published cases of anti-NMDA receptor encephalitis was performed from inception to January 2018. There were 706 cases of anti-NMDA receptor encephalitis identified. Cases were typically young (mean age 22.6years, SD 14.8), female (F:M ratio 3.5:1) and presented with significant behavioural disturbance. Reported behaviour was most commonly severe agitation and aggression, abnormal speech, and catatonia. Psychosis occurred in 45.8% of cases. Investigation results were inconsistent (MRI abnormal in 35.6%, EEG abnormal in 83.0%) and non-specific. Psychiatric treatment often required multiple psychotropics, and there may be increased risk of significant side-effects such as neuroleptic malignant syndrome. Prognosis was usually good; however, cognitive and behavioral symptoms remained prominent during recovery, and psychiatrist involvement was required in this period. The presentation of anti-NMDA receptor encephalitis is variable. However, there are often psychiatric features which are atypical to a primary psychiatric illness, such as severe agitation, speech abnormalities, and catatonia, which may help early identification.

First reported cases of anti-NMDA receptor encephalitis in Vietnamese adolescents and adults

IntroductionAnti-NMDA receptor encephalitis is increasingly recognised as an important differential diagnosis in patients with encephalitis of unknown aetiology. We report the first case series of patients diagnosed in Vietnam. MethodsSamples of CSF from patients with presumed encephalitis but negative microbiological investigations, who exhibited dyskinesia, autonomic instability or psychosis were tested for antibodies against the NR1 subunit of the glutamate (type-NMDA) receptor using an indirect immunofluorescence assay. ResultsOf 99 patients admitted with all-cause encephalitis over an 18month period, 9.1% (n=9 patients, 5 female, median age 28years) had confirmed NMDAR encephalitis. All patients were admitted from one mental health hospital, and the incidence may therefore be an underestimate. Common features included reduction in speech (n=9), catatonia (n=9), convulsions (n=7), dyskinesia (n=9), rigidity (n=9) and autonomic dysfunction (n=7). Aside from a modest lymphocytic pleocytosis, routine CSF analysis was usually normal. No female patient had ovarian teratoma detected by abdominal ultrasound. Most patients were treated with high dose corticosteroids, and one patient received intravenous immunoglobulin. The median duration of hospitalization was 75days and no patient died during admission. ConclusionsAnti-NMDA receptor encephalitis is an important differential diagnosis to consider for patients presenting with acute onset psychiatric symptoms, who develop ensuing seizures, movement or autonomic disorder in Vietnam. A stronger evidence base for management and access to second line immunotherapy agents may help to reduce morbidity from this disease.

A case of anti-NMDA receptor encephalitis with ADEM-like clinical/MR findings

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Management of psychiatric symptoms in pediatric anti-NMDA receptor encephalitis: Case report and systematic review

Introduction Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune condition that causes serious psychiatric symptoms. Nearly 40% of affected patients are pediatric in age. Few publications detail management of psychiatric symptoms. Objective To guide clinical decision-making for psychiatrists managing pediatric patients with anti-NMDA receptor encephalitis. Aims We present a systematic review of literature and an illustrative case report of a 17-year-old girl who presented with psychosis, agitation, and insomnia, and underwent treatment with olanzapine, clonazepam, and clonidine. Methods PUBMED was searched for publications in English describing anti-NMDA encephalitis (2007–November 2015). Publications were included if they met all of the following: – novel data; – reported treatment of psychiatric phenomena for patients aged ≤18 years – full text available. Thirty-four publications detailing 38 unique cases were included. Results Psychiatric symptoms are summarized in Table 1; common treatment modalities are presented in Table 2. The most frequently used antipsychotics were risperidone ( n =16, 57%), haloperidol ( n =10, 36%), and olanzapine ( n =10, 36%). Significant adverse effects occurred, with neuroleptic malignant syndrome diagnosed with high probability in 4 cases (13%), and suspected in 5 cases (16%). Dystonia, rigidity, tremors, and bradykinesia were also linked to medication side effects. All reported adverse events coincided with antipsychotic administration. Conclusions Psychiatric symptoms in pediatric cases of anti-NMDA receptor encephalitis were frequently managed with antipsychotics and benzodiazepines. Though antipsychotics may be necessary, serious side effects are concerning. Unlike in delirium resulting from other causes, benzodiazepines do not seem to be contraindicated. ECT may also be of utility and was well-tolerated in reported cases.

Anti-NMDA Receptor Encephalitis in a Pregnant Woman

Anti N-methyl-D-aspartate (NMDA) receptor encephalitis is one of the most common types of autoimmune synaptic encephalitis. Anti-NMDA receptor encephalitis commonly occurs in young women with ovarian teratoma. It has variable clinical manifestations and treatment responses. Sometimes it is misdiagnosed as a psychiatric disorder or viral encephalitis. To the best of our knowledge, anti-NMDA receptor encephalitis is a rare condition in pregnant women. We report a case of anti-NMDA receptor encephalitis in a pregnant woman who presented with abnormal behavior, epileptic seizure, and hypoventilation.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Presenting Progressive Dyslexia: A Case Report

The most common etiology of encephalitis is infection. However, immune-mediated etiologies of encephalitis are now increasingly recognized. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis was first identified in 2007 by Dalmau and Bataller.1 Its characteristics include impaired consciousness, psychosis, seizures, dyskinesia, autonomic instability, and other various symptoms.2 Among these symptoms, rapid progressive psychosis is the first symptom of the disease in most cases. We experienced a case of anti-NMDA receptor encephalitis with phonemic paraphasia and acalculia as first symptoms that were not classical characteristics. CASE REPORT