Anti-NMDA receptor encephalitis with associated catatonia during pregnancy
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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.
KeywordsAutoimmune encephalitis NMDA receptor Catatonia Pregnancy
Conflicts of interest
The authors declare that they have no conflicts of interest.
The patient described has given written consent for the use of patient identifiable video material.
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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