A juvenile female patient with non paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis

Abstract

Since the report of Dalmau et al. in 2007, anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has received an increasing amount of attention. This condition accounts for some cases of limbic encephalitis and is often paraneoplastic. Here, we report a patient with non paraneoplastic anti-NMDA receptor encephalitis. A 29-year-old woman was admitted to our intensive care unit because of aspiration pneumonia and intractable convulsions. After experiencing common cold symptoms, the patient developed psychiatric symptoms, such as hallucinations and delusions, and persistent limbic convulsions in spite of the administration of several anticonvulsants prior to admission. Her laboratory studies and electroencephalographic examinations were not significant, and no tumor was found. However, a spinal fluid examination revealed a mild elevation in mononuclear cells and protein and the existence of anti-glutamate receptor antibodies, indicating that the limbic encephalitis might have been caused by autologous antibodies. The patient quickly recovered from the pneumonia in response to appropriate antibiotics and respiratory management, and her convulsions (and psychiatric symptoms) were ameliorated with steroid therapy. Limbic encephalitis, including anti-NMDA receptor encephalitis, remains unfamiliar to many physicians, but awareness of this condition is important as anti-NMDA receptor encephalitis accounts for a relevant proportion of unexplained, new-onset convulsions and psychiatric symptoms and is responsive to several therapies, with a favorable prognosis.