Anti-NMDAR Encephalitis: Higher Suspicious Needed for Earlier Diagnosis (Case Report, Literature Review and Diagnostic Criteria)

Abstract

Background. Auto-immune mediated anti-NMDA receptor encephalitis is a very common delayed diagnosed encephalitis which predominately affecting young population. Objectives. This encephalitis is relatively unknown amongst emergency physicians and a majority of patients are admitted to psychiatric wards before their diagnosis is confirmed and appropriate treatments are commenced. We reported a case of a 22-year-old female presented to our emergency department with acute psychiatric symptoms. She was initially diagnosed with first presentation of acute psychosis and was hospitalised under mental health act. further assessment in the emergency department identified possible an organic cause for her acute psychosis and she was later admitted under medical team after her mental health assessment order was revoke. Several days later, her CSF result was positive with anti-NMDA receptor anti-bodies. Appropriate treatments were instituted leading to her full recovery. Conclusion. This case was the first confirmed anti-NMDA receptor encephalitis in our emergency department. It highlights the importance of thorough assessment of psychiatric presentations to emergency departments and consideration of auto-immune medicated encephalitis as one of the differential diagnosis in young patients presenting with first acute psychotic episode.

Encefalitis anti-receptor NMDA: un diagnóstico a considerar

“…La encefalitis anti-receptor de N-metil-D-aspartato (NMDAR), es la inflamación del parénquima cerebral, secundaria a la presencia de anticuerpos contra el receptor de glutamato NMDA en las sinapsis neuronales, que finalmente se manifiesta como una disfunción neurológica (1,4,7).…”

“…Se informa una incidencia de 5-10 por 100.000 habitantes por año de encefalitis autoinmune en países de altos ingresos (1), al momento no se cuenta con datos epidemiológicos en América Latina ni en Colombia. La encefalitis anti-NMDAR se encuentra entre las encefalitis más comunes, después de las encefalitis desmielinizantes y afecta con mayor frecuencia a la población de mediana edad (4,5,8). Aunque la afección se ha descrito en ambos sexos, las mujeres, representan el 80% de los casos notificados, siendo el teratoma de ovario y la infección por virus del herpes simple (VHS) los desencadenantes más frecuentes (4,5,9).…”

“…La encefalitis por anti-receptor N-Metil-D-Aspartato (NMDAR) es una causa común de este tipo de patologías. Esta afección, fue descrita por Dalmau y col. en el 2007, en una cohorte de 12 mujeres con teratomas ováricos que desarrollaron síntomas psiquiátricos, déficit de memoria, convulsiones, disquinesias e inestabilidad autonómica asociados a deterioro de estado de conciencia (2,4,5).…”

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Detailed Review of the Different Psychiatric Presentations and Red Flags to Look for in Suspected Cases

“…Hence, in young patients who present with features of plausible anti-NMDAR encephalitis with a negative initial autoimmune screen, the next set of orders should be either CSF testing for pleocytosis, oligoclonal bands, or an EEG. If either of these tests comes back with abnormal findings, anti-NMDAR encephalitis diagnosis could be established, and treatment can be commenced without any further delay [14,47].…”

“…Because this disorder is a relatively new diagnosis, it has become mandatory to thoroughly assess psychiatric manifestations in the emergency department and consider autoimmune encephalitis as a differential diagnosis in young people presenting with acute psychotic episodes [14].…”