1887
Volume 2015, Issue 1
  • ISSN: 0253-8253
  •  E-ISSN:  Will be obtained soon 2227-0426

Abstract

Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is a new autoimmune, often paraneoplastic disorder that presents with complex neuropsychiatric symptoms. It was first described in 2007 by Dalmau et al. Our patient presented with headache, behavioral changes and then seizures with hallucinations. She was initially misdiagnosed to have schizophrenia and was prescribed antipsychotics. She deteriorated and developed further seizures with hypoventilation and choreoathetosis. Her blood investigations were positive for mycoplasma IGM. Her CSF studies showed high white cell counts, predominantly lymphocytes, and high anti-NMDA-R titre. Her brain MRI scans showed high T2 and FLAIR intensities in the grey and white matter of the left cerebellar hemisphere suggestive of acute disseminated encephalomyelitis. She responded to treatment with antibiotics, multiple antiepileptics, steroids and needed five sessions of plasmapheresis. There was no underlying malignancy on repeated scanning of the abdomen. She needed around one year for full recovery with intensive rehabilitation. The objective of this paper was to highlight the occurrence of this fairly new, challenging, easily missed, not-so-rare form of encephalitis often occurring in the absence of fever.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2015.2
2015-05-14
2020-04-05
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2015/1/qmj.2015.2.html?itemId=/content/journals/10.5339/qmj.2015.2&mimeType=html&fmt=ahah

References

  1. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS, UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group . Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population based prospective study. Lancet Infect Dis. 2010; 10::835844.
    [Google Scholar]
  2. Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007; 61::2536.
    [Google Scholar]
  3. Gleichman AJ, Spruce LA, Dalmau J, Seeholzer SH, Lynch DR. Anti-NMDA Receptor Encephalitis Antibody Binding Is Dependent on Amino Acid Identity of a Small Region within the GluN1 Amino Terminal Domain. J Neurosci. 2012; 32::1108211094.
    [Google Scholar]
  4. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011; 10::6374.
    [Google Scholar]
  5. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008; 7::10911098.
    [Google Scholar]
  6. Gable MS, Gavali S, Radner A, Tilley DH, Lee B, Dyner L, Collins A, Dengel A, Dalmau J, Glaser CA. Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis. Eur J Clin Microbiol Infect Dis. 2009; 28::14211429.
    [Google Scholar]
  7. Kleinig TJ, Thompson PD, Matar W, Duggins A, Kimber TE, Morris JG, Kneebone CS, Blumbergs PC. The distinctive movement disorder of ovarian teratoma-associated encephalitis. Mov Disord. 2008; 23::12561261.
    [Google Scholar]
  8. Armangue T, Titulaer MJ, Málaga I, Bataller L, Gabilondo I, Graus F, Dalmau J, Spanish Anti-N-methyl-D-Aspartate Receptor (NMDAR) Encephalitis Work Group . Pediatric Anti-NMDAR encephalitis-Clinical analysis and novel findings in a series of 20 patients. J Pediatr. 2013; 162:4:850856.
    [Google Scholar]
  9. Gresa Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F. Antibody titres at diagnosis and during followup of antiNMDA receptor encephalitis: a retrospective study. Lancet Neurol. Feb;. 2014; 13:2:16777.
    [Google Scholar]
  10. Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS, Friese MA, Galea I, Kullmann DM, Beeson D, Lang B, Bien CG, Vincent A. N-methyl-D-aspartate antibody encephalitis: Temporal progression of clinical and paraclinical observations in a predominantly nonparaneoplastic disorder of both sexes. Brain. 2010; 133::16551667.
    [Google Scholar]
  11. Adang LA, Lynch DR, Panzer JA. Pediatric anti-NMDA receptor encephalitis is seasonal. Annals of Clinical and Translational Neurology Annals of Clinical and Translational Neurology. 2014; 1:11:921925.
    [Google Scholar]
  12. Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis: a cohort study. Lancet Neurol. 2013 February; 12:2:157165.
    [Google Scholar]
  13. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, Parsons TD, Lynch DR, Dalmau J, Balice-Gordon RJ. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010; 30::58665875.
    [Google Scholar]
  14. Taguchi Y, Takashima S, Nukui T, Tanaka K. Reversible “brain atrophy” in anti-NMDA receptor encephalitis. Intern Med. 2011; 50::2697.
    [Google Scholar]
  15. Consoli A, Ronen K, An-Gourfinkel I, Barbeau M, Marra D, Costedoat-Chalumeau N, Montefiore D, Maksud P, Bonnot O, Didelot A, Amoura Z, Vidailhet M, Cohen D. Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: case report. Child Adolesc Psychiatry Ment Health. 2011; 5::15.
    [Google Scholar]
  16. Chan SH, Wong VC, Fung CW, Dale RC, Vincent A. Anti-NMDA receptor encephalitis with atypical brain changes on MRI. Pediatr Neurol. 2010; 43::274278.
    [Google Scholar]
  17. Finke C, Kopp UA, Scheel M, Pech LM, Soemmer C, Schlichting J, Leypoldt F, Brandt AU, Wuerfel J, Probst C, Ploner CJ, Prüss H, Paul F. Functional and structural brain changes in anti-N-methyl-D-aspartate receptor encephalitis. Ann Neurol. Aug;. 2013; 74:2:284296.
    [Google Scholar]
  18. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012; 79::10941100.
    [Google Scholar]
  19. Tuzun E, Zhou L, Baehring JM, Bannykh S, Rosenfeld MR, Dalmau J. Evidence for antibody mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma. Acta Neuropathol. 2009; 118::73743.
    [Google Scholar]
  20. Florance-Ryan N, Dalmau J. Update on anti-N-methyl-D-aspartate receptor encephalitis in children and adolescents. Curr Opin Pediatr. 2010; 22::739744.
    [Google Scholar]
  21. Iizuka T, Sakai F, Ide T, Monzen T, Yoshii S, Iigaya M, Suzuki K, Lynch DR, Suzuki N, Hata T, Dalmau J. Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology. 2008; 70::504511.
    [Google Scholar]
  22. Sabin TD, Jednacz JA, Staats PN. Case records of the Massachusetts General Hospital. Case 26-2008. A 26-year-old woman with headache and behavioral changes. N Engl J Med. 2008; 359::842853.
    [Google Scholar]
  23. Gabilondo I, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Viñals M, Villoslada P, Graus F. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011; 77::996999.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2015.2
Loading
/content/journals/10.5339/qmj.2015.2
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error