Central Neurogenic Hyperventilation in Anti-NMDA Receptor Encephalitis

Vural, Atay; Arsava, Ethem Murat; Deri̇ci̇oğlu, Neşe; Topçuoğlu, Mehmet Akif

doi:10.2169/internalmedicine.51.8215

Cited by 24 publications

(8 citation statements)

References 14 publications

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“…Central hypoventilation is a significant clinical feature of anti-NMDAR encephalitis. However, similarly to a report from Vural et al [ 32 ], the patient in the second case suffered from hyperventilation, which was possibly central neurogenic hyperventilation. The inactivation of GABAergic neurons due to an antibody-mediated decrease in NMDA receptors may be involved in the complexity of some abnormal movements via disinhibition of a brainstem central pattern generator [ 33 ], which is the possible underline mechanism of central neurogenic hyperventilation.…”

Section: Discussionsupporting

confidence: 79%

Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

et al. 2015

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BackgroundAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an immune-mediated syndrome caused by the production of anti-NMDAR receptor antibodies. The syndrome characterised by psychosis, seizures, sleep disorders, hallucinations and short-term memory loss. Ovarian teratoma is the confirmed tumour associated with anti-NMDAR antibodies. The patients with anti-NMDAR encephalitis complicated by ovarian teratoma require surgical treatment under general anesthesia. NMDARs are important targets of many anesthetic drugs. The perioperative management and complications of anti-NMDAR encephalitis, including hypoventilation, paroxysmal sympathetic hyperactivity (PSH) and epilepsy, are challenging for ansthesiologists.Case presentationThis report described two female patients who presented for resection of the ovarian teratoma, they had confirmed anti-NMDAR encephalitis accompanied by ovarian teratoma. Two patients received gamma globulin treatments and the resection of the ovarian teratoma under total intravenous anesthesia. They were recovered and discharged on the 20th and 46th postoperative day respectively.ConclusionsThere is insufficient evidence about the perioperative management, monitoring and anesthesia management of anti-NMDAR encephalitis. This report was based on the consideration that controversial anesthetics that likely act on NMDARs should be avoided. Additionally, BIS monitoring should to be prudently applied in anti-NMDAR encephalitis because of abnormal electric encephalography (EEG). Anesthesiologists must be careful with regard to central ventilation dysfunctions and PSH due to anti-NMDAR encephalitis.

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Section: Discussionsupporting

confidence: 79%

Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

et al. 2015

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“…A previous study indicated that orofacial-lingual dyskinesia, tremor, and dystonia were the common types of involuntary movements in anti-NMDAR encephalitis 13. Histological data have revealed the distribution of NMDAR in the brainstem, but the cause of central hypoventilation in patients with anti-NMDAR encephalitis remains unclear—it may be associated with secondary brainstem lesions or a functional neurotransmitter imbalance 1415. Severe patients exhibiting decreased consciousness and central hypoventilation generally require artificial-airway- and ventilator-assisted breathing, while involuntary movements of the face and dystonia may have a considerable impact on airway management 12…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting the Response to First-Line Treatments in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

et al. 2019

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Background and Purpose Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. This study aimed to explore the possible factors affecting the response to first-line treatments in patients with anti-NMDAR encephalitis. Methods We enrolled 29 patients who were diagnosed as anti-NMDAR encephalitis between January 1, 2015, and June 30, 2018. They were divided into the remission and nonremission groups according to their response to first-line treatments. The demographics, clinical manifestations, main ancillary examinations, follow-up treatments, and prognosis of patients were recorded. The symptoms reported on in this study occurred before treatments or during the course of first-line treatments. Results There were 18 patients (62.07%) in the remission group and 11 patients (37.93%) in the nonremission group. Compared to the remission group, a higher proportion of the patients in the nonremission group exhibited involuntary movements, decreased consciousness, central hypoventilation, lung infection, and hypoalbuminemia. The nonremission group had a high incidence of increased intracranial pressure and significant elevations of the neutrophil-to-lymphocyte ratio in peripheral blood (NLR), aspartate aminotransferase, and fibrinogen. Six patients (54.55%) in the nonremission group received second-line immunotherapy. Only one patient (3.45%) died, which was due to multiple-organ failure. Conclusions Anti-NMDAR-encephalitis patients with more symptoms—especially involuntary movements, disturbance of consciousness, central hypoventilation, and accompanying hypoalbuminemia and pulmonary infection—may respond poorly to first-line treatments. Positive second-line immunotherapy therefore needs to be considered. Admission to an intensive-care unit, increased cerebrospinal fluid pressure, and increased NLR might be the significant factors affecting the response to first-line treatments.

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“…In addition to those characteristic manifestations, central neurogenic hyperventilation has been reported in such patients [60]. The cranial nerves are also involved in anti-NMDAR encephalitis.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Anti-N-Methyl-D-aspartate Receptor Encephalitis: A Severe, Potentially Reversible Autoimmune Encephalitis

Liu

Zhu

Zheng

et al. 2017

Mediators of Inflammation

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is potentially lethal, but it is also a treatable autoimmune disorder characterized by prominent psychiatric and neurologic symptoms. It is often accompanied with teratoma or other neoplasm, especially in female patients. Anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum are characteristic features of the disease, thereby suggesting a pathogenic role in the disease. Here, we summarize recent studies that have clearly documented that both clinical manifestations and the antibodies may contribute to early diagnosis and multidisciplinary care. The clinical course of the disorder is reversible and the relapse could occur in some patients. Anti-NMDAR encephalitis coexisting with demyelinating disorders makes the diagnosis more complex; thus, clinicians should be aware of the overlapping diseases.

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Central Neurogenic Hyperventilation in Anti-NMDA Receptor Encephalitis

Cited by 24 publications

References 14 publications

Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

Factors Affecting the Response to First-Line Treatments in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Anti-N-Methyl-D-aspartate Receptor Encephalitis: A Severe, Potentially Reversible Autoimmune Encephalitis

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