Acute neuropsychiatric manifestations of anti-N-methyl-D-aspartate receptor encephalitis

Abstract

Autoimmune limbic encephalitis (ALE) is a well-characterized neuropsychiatric syndrome with associated neuroimaging and immunological diagnostic markers.1 Importantly, because of the predominant psychiatric symptoms in a majority of patients, most patients are seen initially by psychiatrists.2 Immune-mediated encephalitis can be paraneoplastic and several antibodies to onconeural antigens have been identified.3 A relatively new clinical subsyndrome of ALE has been identified in young women, often associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) and usually with a set of striking clinical features, including changes in personality, mood and anxiety symptoms, psychosis, bizarre behavior and catatonia.2,4 Although more than 50% of cases are associated with a tumor, especially ovarian teratoma, there are cases where no such association could be demonstrated, especially in younger patients.2,5 The characteristic clinical features of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are a prodromal flu-like illness followed by a range of psychiatric, neurological and autonomic symptoms and signs.4,6 (Taken from first paragraph). Show more