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Anti-NMDA receptor encephalitis with associated catatonia during pregnancy

Abstract

Anti-NMDA-R encephalitis has been described as a cause of acute psychosis in young females. It is rare during pregnancy. We describe a primigravida 32-year-old woman with acute onset psychosis during the first trimester. Eight weeks after becoming pregnant, the patient became psychotic with associated catatonia and autonomic disturbance. Serum anti-NMDA-R antibodies were found. She responded to plasma exchange. At caesarean section, a healthy baby boy was born and a benign mature cystic teratoma was removed from the left ovary. Catatonia associated with psychosis may occur in pregnancy secondary to anti-NMDA-R encephalitis. Prompt and aggressive treatment can lead to a good outcome for both baby and mother.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

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The patient described has given written consent for the use of patient identifiable video material.

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Correspondence to A. McCarthy.

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Clinical course during the patients’ hospital stay. Segment 1: 6 days post admission, during EEG recording on the psychiatry ward, on anti-psychotic medication only. Segment 2: 9 days post admission, commenced on IV methylprednisolone on this day. Catatonia is evident, as well as stereotyped movements of the right hand. Segment 3: 12 days post admission, has received 4 days of IV steroids and commences plasma exchange on this day. Forced eye closure and neck rigidity is evident. Segment 4: 3 weeks post admission, remains on plasma exchange. The patient is less rigid with spontaneous eye opening and disappearance of the catatonia. Persistent tachycardia is evident on the monitor. Segment 5: 8 weeks post admission, walking with minimal assistance, normal neurological exam, and cognitive assessment (MPG 61786 kb)

Clinical course during the patients’ hospital stay. Segment 1: 6 days post admission, during EEG recording on the psychiatry ward, on anti-psychotic medication only. Segment 2: 9 days post admission, commenced on IV methylprednisolone on this day. Catatonia is evident, as well as stereotyped movements of the right hand. Segment 3: 12 days post admission, has received 4 days of IV steroids and commences plasma exchange on this day. Forced eye closure and neck rigidity is evident. Segment 4: 3 weeks post admission, remains on plasma exchange. The patient is less rigid with spontaneous eye opening and disappearance of the catatonia. Persistent tachycardia is evident on the monitor. Segment 5: 8 weeks post admission, walking with minimal assistance, normal neurological exam, and cognitive assessment (MPG 61786 kb)

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McCarthy, A., Dineen, J., McKenna, P. et al. Anti-NMDA receptor encephalitis with associated catatonia during pregnancy. J Neurol 259, 2632–2635 (2012). https://doi.org/10.1007/s00415-012-6561-z

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Keywords

  • Autoimmune encephalitis
  • NMDA receptor
  • Catatonia
  • Pregnancy