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Anti‐ N ‐methyl‐D‐aspartate receptor antibody encephalitis: A back‐to‐front presentation
Author(s) -
Rathakrishnan Rahul,
Yuki Nobuhiro
Publication year - 2013
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.51
Subject(s) - medicine , encephalitis , dystonia , dysautonomia , pediatrics , delirium , anxiety , depression (economics) , psychiatry , immunology , pathology , disease , virus , economics , macroeconomics
The anti‐ N ‐methyl‐D‐aspartate receptor ( NMDAR ) encephalitis is a multiphasic immune‐mediated syndrome with a unique evolution of clinical features. Patients usually present with psychiatric symptoms, such as anxiety, delusions and paranoia, followed by disturbance of speech and obtundation. Some develop movement disorders, characteristically oro‐facial dyskinesias. Dystonia as a presenting feature in adults is unusual. Complex partial seizures and dysautonomia might require intensive care. We describe an adult with anti‐ NMDAR encephalitis who presented atypically. Dystonia and oculogyric crisis were then followed by cognitive dysfunction and impairment of consciousness. Psychiatric features manifested 25 days after presentation. The patient made a full recovery after immunosuppressive treatment. The atypical sequence of clinical features suggests a subcortical‐to‐cortical pathway of involvement. Anti‐ NMDAR encephalitis might be underdiagnosed in patients with unusual manifestations.