Anti-NMDA-Receptor Encephalitis: Case Report and Literature Review of an Under-Recognized Condition
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Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is an immune-mediated syndrome that remains under-recognized despite a growing body of literature. This syndrome has been predominantly described in young females with a constellation of symptoms, including personality changes, autonomic dysfunction and neurologic decompensation. It is commonly associated with mature ovarian teratomas. We describe the classic presentation of anti-NMDA-R encephalitis in three dramatically different patients: Case A, a young woman with ovarian teratoma; Case B, the eldest case reported to date; and Case C, a young male with no identifiable tumor. We review the literature summarizing the differential diagnosis, investigative approach, treatment options and challenges inherent to this disorder. We advocate good supportive care, involvement of multiple health disciplines and use of immune-modulating therapies in patient management. These cases underscore the need for increased awareness and high diagnostic suspicion when approaching the patient with suspected viral encephalitis.
KEY WORDSencephalitis NMDA-receptor teratoma autoimmune
We wish to thank our patients’ families for their cooperation and willingness to participate in physician education. We also wish to acknowledge the excellent care provided by our colleagues in medicine, nursing and affiliated services. Finally, we wish to express our gratitude to Dr. Allan Detsky for his constructive comments and advice concerning this manuscript, and Dr. Josep Dalmau and his laboratory for serum and CSF analysis identifying anti-NMDA-R antibodies.
Case A was presented in abstract form (author B.C.) at the Canadian Society of Internal Medicine 2009 Annual Scientific Meeting (October 23, 2009).
Conflicts of Interest
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