Management And Psychiatric Manifestations Of Anti-NMDA Receptor Encephalitis, A Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S525-S526
Author(s):  
R. Gallego ◽  
A. Flores
Keyword(s):  
Case Report ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Multidisciplinary Treatment ◽  
Autoimmune Disorder ◽  
Clonic Seizure ◽  
Nmda Receptor Encephalitis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Psychiatric Manifestations

IntroductionAnti-NMDA receptor (NMDAR) encephalitis, formally recognized in 2007 by Dalmau et al, is an autoimmune disorder with a complex presentation that includes psychiatric symptoms, memory deficits, and autonomic instability. The exact incidence is unknown but age, gender, and ethnicity may all play a role. Presence of antibodies against the GluN1 subunit of the NMDAR in the CSF and serum confirm the diagnosis of NMDAR encephalitis.Case reportWe report the case of a previously healthy, 19-year-old woman, 6 weeks pregnant. She had a generalized tonic-clonic seizure followed by psychiatric symptoms, including insomnia, emotional lability, delusions, and disorganized behavior. During the course of the disease, she demonstrated speech impairments and catatonic features associated with abnormal movements.She was provided lorazepam 1 mg twice a day to treat her catatonic symptoms, her insomnia and her speech improved. Olanzapine was introduced, reaching a dose of 20 mg/day for managing psychosis and agitation.DiscussionNMDA-R encephalitis is a novel disorder with prominent psychiatric manifestations that is widely underdiagnosed. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Benzodiazepines are helpful for agitation, insomnia and catatonia associated with this condition.ConclusionEarlier recognition of this illness is crucial as prompt diagnosis and multidisciplinary treatment, can potentially improve prognosis. There is an increasing need for psychiatrists to become aware of the disorder and consider it in their differential diagnosis, specially in patients with new onset psychosis, history of encephalitis or subtle neurological symptoms. Careful selection of psychopharmacological interventions may reduce suffering.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric Symptoms in a Patient with NMDA Receptor Encephalitis

2020 ◽  
Vol 9 (1) ◽  
pp. 66-68
Author(s):  
L Paudel ◽  
S Samadarshi ◽  
S Limbu ◽  
R Sharma ◽  
P Chalise ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Autoimmune Disorder ◽  
Behavioral Changes ◽  
Psychiatric Consultation ◽  
Course Of Illness ◽  
Nmda Receptor Encephalitis ◽  
Abnormal Movements ◽  
Aspartate Receptor ◽  
Autonomic Instability ◽  
Psychiatric Manifestations

Anti N methyl D aspartate receptor (NMDA-R) encephalitis is an autoimmune disorder that encompasses various psychiatric and neurological symptoms. Psychiatric manifestations are often the presentation of the disease that often delay or mislead the diagnosis. Complex psychiatric symptoms, seizures, autonomic instability, abnormal movements, behavioral changes and impaired cognitive functions are present during the course of illness. Prodromal psychiatric symptoms often confuse the physicians and even patient initially seeks psychiatric consultation. Here we present a case of 19 years female who presented with initial psychiatric symptoms that progressed to seizure, autonomic instability, abnormal movement and other encephalitic symptoms.

scholarly journals Phylogenetic Analysis to Explore the Association Between Anti-NMDA Receptor Encephalitis and Tumors Based on microRNA Biomarkers

Biomolecules ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. 572 ◽  
Author(s):  
Wang
Keyword(s):  
Phylogenetic Analysis ◽  
Nmda Receptor ◽  
Phylogenetic Trees ◽  
Tumor Resection ◽  
Autoimmune Disorder ◽  
Control Of Gene Expression ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Non Coding Rna ◽  
The Relationship

MicroRNA (miRNA) is a small non-coding RNA that functions in the epigenetics control of gene expression, which can be used as a useful biomarker for diseases. Anti-NMDA receptor (anti-NMDAR) encephalitis is an acute autoimmune disorder. Some patients have been found to have tumors, specifically teratomas. This disease occurs more often in females than in males. Most of them have a significant recovery after tumor resection, which shows that the tumor may induce anti-NMDAR encephalitis. In this study, I review microRNA (miRNA) biomarkers that are associated with anti-NMDAR encephalitis and related tumors, respectively. To the best of my knowledge, there has not been any research in the literature investigating the relationship between anti-NMDAR encephalitis and tumors through their miRNA biomarkers. I adopt a phylogenetic analysis to plot the phylogenetic trees of their miRNA biomarkers. From the analyzed results, it may be concluded that (i) there is a relationship between these tumors and anti-NMDAR encephalitis, and (ii) this disease occurs more often in females than in males. This sheds light on this issue through miRNA intervention.

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms

2018 ◽  
Vol 49 (16) ◽  
pp. 2709-2716 ◽  
Author(s):  
Ronald J. Gurrera
Keyword(s):  
Nmda Receptor ◽  
Clinical Features ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Signs And Symptoms ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Unexplained Fever ◽  
Study Inclusion

AbstractBackgroundAnti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder.MethodsA systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains.ResultsTwo hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals.ConclusionsClinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

scholarly journals Anti- NMDAR Autoimmune Encephalitis Presenting as Acute Psychosis: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 59-61
Author(s):  
Bibek Rajbhandari ◽  
Minani Gurung
Keyword(s):  
Behavioral Change ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
Clinical Findings ◽  
Acute Psychosis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Long Time ◽  
Autonomic Instability

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. We present a case of a 13-year old who presented with noticeably chirpiness, excessive talking with unknown people and wandering around the neighborhood without purpose.The main symptoms of the patient and the important clinical findings were irrelevant talking which later developed into slurring of speech, abnormal movements and memory loss.This case is an example of how easily we are misled towards diagnosis based on the present symptoms. The patient suffered the unnecessary stigma of a psychiatric illness, which might stay imprinted on her for a long time. In this report we call for attention to the inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis. It adds on to show that NMDAR might present in the most unexpected and unpredictable ways, sometimes misleading the patient away from medical help.Prompt diagnosis is critical as early immunotherapy and tumor removal could dramatically affect outcomes.

scholarly journals Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Stavrou ◽  
Jing Ming Yeo ◽  
Alexander David Slater ◽  
Oliver Koch ◽  
Sarosh Irani ◽  
...  
Keyword(s):  
Case Report ◽  
Nmda Receptor ◽  
Rapid Development ◽  
Clonic Seizure ◽  
Ovarian Teratoma ◽  
Caucasian Woman ◽  
Case Presentation ◽  
Nmda Receptor Encephalitis ◽  
Autonomic Instability ◽  
Lymphocytic Meningitis

Abstract Background Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia. Case presentation This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma. Conclusion Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.

scholarly journals Anti-NMDA Receptor Encephalitis in a Patient with Previous Psychosis and Neurological Abnormalities: A Diagnostic Challenge

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
R. David Heekin ◽  
Maria C. Catalano ◽  
Alfred T. Frontera ◽  
Glenn Catalano
Keyword(s):  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Memory Loss ◽  
Autoimmune Disorder ◽  
Diagnostic Challenge ◽  
Manic Symptoms ◽  
Nmda Receptor Encephalitis ◽  
Autonomic Instability ◽  
Receptor Antibodies

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder characterized by IgG autoantibodies directed against the NR1 subunit of the NMDA glutamate receptor. Psychiatric symptoms are common and include psychosis, mania, depressed mood, aggression, and speech abnormalities. Neurological symptoms such as seizures, decreased responsiveness, dyskinesias, and other movement abnormalities and/or autonomic instability are frequently seen as well. We present the case of a woman who was followed up at our facility for over 14 years for the treatment of multiple neuropsychiatric symptoms. Initially, she presented with paresthesias, memory loss, and manic symptoms. Nine years later, she presented to our facility again, this time with left sided numbness, left eyelid droop, and word finding difficulties. Finally, five years later, she presented with manic symptoms, hallucinations, and memory impairment. During her hospitalization, she subsequently developed catatonic symptoms and seizures. During her stay, it was discovered that she was positive for anti-NMDA receptor antibodies and her symptoms responded well to appropriate therapy. This case demonstrates that it may be useful for clinicians to consider screening for anti-NMDA receptor antibodies in long-term patients with neuropsychiatric symptoms that have not adequately responded to therapy.

scholarly journals A patient with a long history of relapsing psychosis and mania presenting with anti-NMDA receptor encephalitis ten years after first episode

2015 ◽  
Vol 9 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Mateus Mistieri Simabukuro ◽  
Christian Henrique de Andrade Freitas ◽  
Luiz Henrique Martins Castro
Keyword(s):  
Psychiatric Disorders ◽  
Psychiatric Symptoms ◽  
Bipolar Affective Disorder ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
First Episode ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Lack Of Information ◽  
History Of

Anti-N-methyl- D-aspartate receptor (NMDAR) encephalitis is a recently discovered autoimmune disorder, in which antibodies target NMDARs in the brain, leading to their removal from synapses. Early in the disease course, patients often present with marked psychosis and mood disturbances (i.e. mania, depression), explaining why most of these patients are first seen by psychiatrists. Hence, autoimmune encephalitis is receiving growing attention from psychiatry, mainly owing to concerns over misdiagnosing immunomediated and potentially curable disorders as primary psychiatric disorders, such as schizophrenia or major depressive disorder. Although anti-NMDAR encephalitis occurs in the context of new-onset psychiatric symptoms, there is a lack of information on differential diagnosis and treatment of this disorder after a long-term diagnostic history of functional psychiatric disorders. We report a case of a patient with a long history of bipolar affective disorder evolving with anti-NMDAR encephalitis, initially misdiagnosed as non-organic psychosis.

Anti-NMDA Receptor Encephalitis, Vaccination and Virus

2020 ◽  
Vol 25 (43) ◽  
pp. 4579-4588 ◽  
Author(s):  
Hsiuying Wang
Keyword(s):  
Cognitive Impairment ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Autoimmune Disorder ◽  
Neurological Symptoms ◽  
H1n1 Vaccine ◽  
Polio Vaccine ◽  
Nmda Receptor Encephalitis ◽  
Japanese Encephalitis Vaccine

Anti-N-methyl-d-aspartate (Anti-NMDA) receptor encephalitis is an acute autoimmune disorder. The symptoms range from psychiatric symptoms, movement disorders, cognitive impairment, and autonomic dysfunction. Previous studies revealed that vaccination might induce this disease. A few cases were reported to be related to H1N1 vaccine, tetanus/diphtheria/pertussis and polio vaccine, and Japanese encephalitis vaccine. Although vaccination is a useful strategy to prevent infectious diseases, in a low risk, it may trigger serious neurological symptoms. In addition to anti-NMDA receptor encephalitis, other neurological diseases were reported to be associated with a number of vaccines. In this paper, the anti-NMDA receptor encephalitis cases related to a number of vaccines and other neurological symptoms that might be induced by these vaccines were reviewed. In addition, anti-NMDA receptor encephalitis cases that were induced by virus infection were also reviewed.

Anti-NMDA receptor encephalitis in the practice of a psychiatrist on the example of a clinical case

2021 ◽  
pp. 586-593
Author(s):  
Kristina S. Gareeva ◽  
Rinat G. Valinurov ◽  
Dmitriy F. Khritinin
Keyword(s):  
Involuntary Movement ◽  
Multidisciplinary Treatment ◽  
Disease Onset ◽  
Autoimmune Encephalitis ◽  
Ovarian Teratoma ◽  
Nmda Receptor Encephalitis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
The Central Nervous System ◽  
Severity Of The Disease

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disease of the central nervous system (CNS) with prominent neurologic and psychiatric features at disease onset. Anti-NMDAR encephalitis can occur in all ages. The disorder predominantly affects children and young adults, occurs with or without tumour association, and can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years. Primarily presents in the form of mental disorders, seizures, and involuntary movement, and is often accompanied by sleep disorders and prominent speech difficulties. Anti-NMDAR encephalitis in children may present differently than in adults. Children are more likely to have abnormal movements (chorea, incoordination) early in the disease course and also may have atypical motor symptoms such as ataxia or hemiparesis. Children more often have seizures than adults. The classic symptoms of psychosis seen in adults are less common, but behavioral regression is frequently noted. The proper diagnosis and management of autoimmune encephalitis requires a multidisciplinary treatment approach. Ancillary testing with MRI, EEG, lumbar puncture and immunological assessment of cerebrospinal fluid and serum may further support a diagnosis of encephalitis and potentially suggest particular causes. Early immune-modulatory treatment can alleviate the severity of the disease and improve the cure rate. Further study of anti-NMDAR antibody and its related encephalitis would give essential clues for the research of schizophrenia, catatonia, and atypical psychosis.

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