HIDING IN PLAIN SIGHT: ANTI-NMDAR- ENCEPHALITIS IN A 30-YEAR-OLD MALE- A CASE REPORT
Article Sidebar
Main Article Content
Abstract
The most common type of autoimmune encephalitis is anti-NMDAR-encephalitis. It is characterized by IgG antibodies against the GluN1 subunit of the NMDA receptor, leading to marked neuropsychiatric and behavioural symptoms that progress in a subacute manner to seizures, speech abnormalities, and a depressed level of consciousness. In this case report, the clinical course of a 30-year-old man who first received treatment for viral encephalitis after exhibiting normal symptoms is described. CSF showed lymphocytic pleocytosis with normal brain imaging. The EEG demonstrated diffuse slowing and encephalopathy. An autoimmunity encephalitis workup was done after exhaustive investigations for metabolic and infectious causes came back negative. A diagnosis of anti-NMDAR encephalitis was made after antibodies were found in the CSF.
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, et al. Autoimmune encephalitis epidemiology and a comparison to infectious enceph¬alitis. Ann Neurol. 2018;83(1):166-77. DOI:10.1002/ana.25131.
Memon RK, Siddiqui M, Khan R. En¬cephalopathy with behavioral and psy¬chiatric features–firstantibody proven case of Anti-NMDA receptor enceph¬alitis from Pakistan. Pak J Neurol Sci. 2015;10(2):27-9.
Zubair UB, Majid H. Anti-NMDA Re¬ceptor Encephalitis in a Young Girl with Altered Behaviour and Abnormal Movements. J Coll Physicians Surg Pak. 2018;28(8):643-44. DOI:10.29271/ jcpsp.2018.08.643.
Sheikh S, Ahmad A, Ahmed TA. Anti NMDA receptor antibody encephalitis in Pakistan: Clinicopathological fea¬tures and treatment outcomes. J Pak Med Assoc. 2019;69(12):1910-14. DOI:10.5455/JPMA.300185.
Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005;58(4):594-604. DOI: 10.1002/ana.20614.
Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplas¬tic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25- 36. DOI:10.1002/ana.21050.
Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010;30(17):5866-75. DOI: 10.1523/ JNEUROSCI.0167-10.2010.
Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neu¬rol. 2013;12(2):157-65. DOI:10.1016/ S1474-4422(12)70310-1.
Sarkis RA, Coffey MJ, Cooper JJ, Hassan I, Lennox B. Anti-N-Meth¬yl-D-Aspartate Receptor Encephalitis: A Review of Psychiatric Phenotypes and Management Considerations: A Report of the American Neuropsychi¬atric Association Committee on Re¬search. J Neuropsychiatry Clin Neuro¬sci. 2019;31(2):137-42. DOI:10.1176/ appi.neuropsych.18010005.
Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clini¬cal approach to diagnosis of auto¬immune encephalitis. Lancet Neurol. 2016;15(4):391-404. DOI:10.1016/S1474-4422(15)00401-9.
Dalmau J, Lancaster E, Martinez-Her¬nandez E, Rosenfeld MR, Balice-Gor¬don R. Clinical experience and labo¬ratory investigations in patients with anti-NMDAR encephalitis. Lancet Neu¬rol. 2011;10(1):63-74. DOI:10.1016/ S1474-4422(10)70253-2.
Balu R, McCracken L, Lancaster E, Graus F, Dalmau J, Titulaer MJ. A score that predicts 1-year function¬al status in patients with anti-NMDA receptor encephalitis. Neurology. 2019;92(3):e244-e252. DOI:10.1212/ WNL.0000000000006783.