Anti-NMDAR encephalitis, a mimicker of acute infectious encephalitis and a review of the literature

Anti-N-methyl-D-aspartate Receptor Autoimmune Encephalitis: A Case Report

Anti-N-methyl-D-aspartate receptor encephalitis is a form of autoimmune encephalitis with acute or subacute neuropsychiatric symptoms. Despite this fact, due to a couple of factors, this condition remains insufficiently acknowledged and is an under-recognised clinical scenario. We describe a case of a patient presenting with fever, headache and altered sensorium along with a history of disorientation, episodes of abnormal body movements and loss of consciousness in the later phase. She was initially thought to have Status epilepticus with tuberculous meningoencephalitis but her cognitive functions did not improve despite appropriate treatment. She displayed features away from the usual course of disease leading to suspicions of Autoimmune Encephalitis and Anti-N-methyl- D-aspartate receptor reports later confirmed the diagnosis. Methylprednisolone and Intravenous Immunoglobulin was started empirically and she was discharged in stable health with stabilised emotional and cognitive function with Azathioprine and Levetiracetam continued. Our findings suggested early diagnosis and prompt immunotherapy treatment beneficial for the outcome.

Keywords

ase reports; encephalitis; immunotherapy; methylprednisolone.

A scoping review on paraneoplastic autoimmune limbic encephalitis (PALE) psychiatric manifestations

The term limbic encephalitis has been used with an oncological precedent for over 50 years and, since then, has been applied in relation to multiple antibodies found in its etiological process. Over the last decade, the psychiatric community has brought paraneoplastic autoimmune limbic encephalitis (PALE) to a new light, scattering the once known relationships between said screened antibodies responsible for causing limbic encephalitis. Due to the fact that some individuals with this condition have a psychiatric syndrome as an initial manifestation, the aim of this updated scoping review is to reestablish a causal relationship between the onconeuronal autoantibodies, both intracellular and extracellular, possible underlying malignancies and subsequent neuropsychiatric syndrome. In pair with it, there is the idea of sketching a cleaner thorough picture of what poses as psychiatric symptoms as well as possible therapeutics. Even though the always evolving epistemology of the neurosciences achieved a significant unveiling of what includes PALE in its relevant pathological subgroups, the amount of gray literature still is much superior, appealing to a further research with more randomized controlled trials, with larger populations, so that the results corroborate the small amount of data that already exist and posteriorly be applied in the general population.

Fatal Autoimmune Anti-NMDA-Receptor Encephalitis with Poor Prognostication Score in a Young Kenyan Female

Auto-immune N-methyl-D-aspartate receptor encephalitis (NMDARE) is a relatively recently described cause of acute encephalopathy with very few reports from sub-Saharan Africa (SSA). We report a case of NMDARE in a young Kenyan female who was transferred to our facility with headaches, insomnia, behaviour changes and latterly pathognomonic orofacial dyskinesias. We comprehensively ruled out infectious and other inflammatory/auto-immune causes. She was diagnosed with NMDARE by positive antibody testing in serum and cerebrospinal fluid and changes on brain magnetic resonance imaging. She was immunosuppressed with high-dose steroids, intravenous immunoglobulins, plasma exchange and rituximab, and showed signs of neurological improvement clinically and radiologically. Unfortunately, she succumbed to septic shock from prolonged intensive care. This is the first report of NMDARE in an indigenous patient from the eastern SSA. The majority (>80%) of patients are either left with mild disability or make a full recovery after NMDARE, but some factors – which comprise the NMDARE One-Year Functional Status (NEOS) prognostication score – can adversely affect outcome, as was the case in our patient.

Treatment of Anti-NMDA Receptor Encephalitis with Ovarian Teratoma Removal: A Literature Review and Two Case Reports

BACKGROUND

N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis appears common in the world, but the number of clinical cases in Vietnam which were recorded is rare.

CASE REPORT

We describe two new cases of disease in recent years with the aim of contributing to diagnosis and treatment experiences. These cases were noted over the past 3 years with the patients who have been treated at lower levels but have no results. They came to us when symptoms became worse and therefore required prolonged treatment with special intensive care facilities. The atypical and easily confused symptoms are the reasons that make the disease be detected late; leading to a much higher cost of treatment and the complication may appear in the patient. In the past, patients with these manifestations were diagnosed with unexplained encephalitis and severe sequelae or death. Autoimmune encephalitis has many types; NMDA encephalitis associated with ovarian teratoma is the most common autoimmune encephalitis in young women.

CONCLUSION

In conclusion, based on the case report, we hope to contribute some experiences on the diagnosis and the strategy in early treatment. With most female patients at very young age, early treatment to avoid complications will help patients have a quality life and maintain reproductive function.

A case report: anti-NMDA receptor encephalitis

N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis is a potentially fatal autoimmune syndrome in which there is antibody production against the NMDAR causing profound dysregulation of neurotransmission. The syndrome is frequently associated with ovarian teratomas and women are disproportionately affected. Patients most often present with a constellation of neuropsychiatric signs and symptoms, including memory loss, hallucinations, and decreased level of consciousness. This condition is lethal if left untreated. Immunotherapy and surgical resection of the culprit malignancy often results in the rapid resolution of symptoms.