2020
DOI: 10.1016/j.jneuroim.2020.577329
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Bilateral thalamic changes in anti-NMDAR encephalitis presenting with hemichorea and dystonia and acute transient psychotic disorder

Abstract: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is one of the most common causes of autoimmune encephalitis. Both movement disorders and neuropsychiatric manifestations are considered core features of anti-NMDAR encephalitis. Strong clinical suspicion, along with NMDAR antibody positivity in paired sample of serum and cerebrospinal fluid, with supportive MRI changes clinch diagnosis in majority. We herein report a case of a middle-aged woman with subacute behavioral abnormalities, which were so se… Show more

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Cited by 13 publications
(10 citation statements)
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“…Thalamic atrophy is also found in patients with schizophrenia and bipolar disorder ( 27 ). At the same time, in a case report, magnetic resonance imaging of anti-NMDAR encephalitis patients showed bilateral thalamic hyperintensity with limited diffusion ( 28 ), which is consistent with the results of this study. There are extensive structural connections between the thalamus and prefrontal lobe, hippocampus, and other structures ( 29 , 30 ).…”
Section: Discussionsupporting
confidence: 91%
“…Thalamic atrophy is also found in patients with schizophrenia and bipolar disorder ( 27 ). At the same time, in a case report, magnetic resonance imaging of anti-NMDAR encephalitis patients showed bilateral thalamic hyperintensity with limited diffusion ( 28 ), which is consistent with the results of this study. There are extensive structural connections between the thalamus and prefrontal lobe, hippocampus, and other structures ( 29 , 30 ).…”
Section: Discussionsupporting
confidence: 91%
“…Paraneoplastic or autoimmune encephalitis is characterized by auto-antibodies that target neuronal tissue and can cause a spectrum of neuropsychiatric symptoms, including encephalopathy, psychosis, seizures and abnormal movements. The best described of these is anti-N-methyl-D-Aspartate (NMDA) receptor encephalitis, which results in characteristic facial dyskinesia as well as other hyperkinetic movements such as hemichorea [ 78 79 80 ]. Although hemichorea is not usually the only presenting symptom, cases have been reported with movement disorders, including hemichorea, preceding the more recognizable psychiatric or cognitive symptoms [ 80 ].…”
Section: Resultsmentioning
confidence: 99%
“…In our patients, WE was initially suspected based on the imaging findings, but it was ruled out because there was no history of heavy alcohol consumption, chronic malnutrition, or thiamine deficiency. The imaging findings of bilateral thalamic lesions could have indicated other diseases, such as Japanese encephalitis, Leigh syndrome, Creutzfeldt–Jakob disease, and cerebrovascular disease (top of the basilar syndrome) [ 19 ]. However, no findings characteristic of any of these diseases were noted in the history or upon examination.…”
Section: Discussionmentioning
confidence: 99%