Anti-NMDA receptor encephalitis with paroxysmal sympathetic hyperactivity: an under-recognized association?
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While autonomic instability occurs as part of anti-N-methyl D-aspartate (anti-NMDA) receptor encephalitis, anti-NMDA receptor encephalitis is not a recognized cause of the clinical syndrome of paroxysmal sympathetic hyperactivity (PSH). We present a case of anti-NMDA receptor encephalitis in which PSH was a cardinal feature and discuss the mechanistic implications of such an association.
A 31-year-old woman had a generalized tonic–clonic seizure and then developed progressively worsening neuropsychiatric symptoms, including mania, hallucinations, echolalia, and suicidal ideation. She was previously healthy; she did not have any known medical or psychiatric disease. She was not on any medications prior to presentation. She was initially admitted to a psychiatric unit but was transferred to a medical ward after one week of psychiatric treatment, as her symptoms worsened despite anti-psychotic medications. Neurologic examination was notable for catatonia that progres ...
- Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 10(1):63–74 CrossRef
- Dalmau J, Gleichman AJ, Hughes EG et al (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 7(12):1091–1098 CrossRef
- Lv L-Q, Hou L-J, Yu M-K et al (2010) Prognostic influence and magnetic resonance imaging findings in paroxysmal sympathetic hyperactivity after severe traumatic brain injury. J Neurotrauma 27(11):1945–1950 CrossRef
- Diesing TS, Wijdicks EFM (2006) Arc de cercle and dysautonomia from anoxic injury. Mov Disord 21(6):868–869 CrossRef
- Perkes I, Baguley IJ, Nott MT, Menon DK (2010) A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann. Neurol. 68(2):126–135 CrossRef
- Rabinstein AA, Benarroch EE (2008) Treatment of paroxysmal sympathetic hyperactivity. Curr Treat Options Neurol. 10(2):151–157 CrossRef
- Goddeau RP Jr, Silverman SB, Sims JR (2007) Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia. Neurocrit Care 7(3):217–220 CrossRef
- Baguley IJ, Heriseanu RE, Gurka JA, Nordenbo A, Cameron ID (2007) Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series. J. Neurol. Neurosurg. Psychiatr. 78(5):539–541 CrossRef
- Baguley IJ (2008) The excitatory: inhibitory ratio model (EIR model): An integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses 70(1):26–35 CrossRef
- Gabriel Pryzbylkowski P, Jonathan Dunkman W, Liu R, Chen L (2011) Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Its Anesthetic Implications. Anesth Analg 113(5):1188–1191 CrossRef
- Anti-NMDA receptor encephalitis with paroxysmal sympathetic hyperactivity: an under-recognized association?
Clinical Autonomic Research
Volume 23, Issue 2 , pp 109-111
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- 1. Department of Neurology and Neurocritical Care, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR, 97239, USA
- 2. Brain Injury Rehabilitation Service, Westmead Hospital, University of Sydney, Sydney, Australia