Anti-NMDA Receptor Encephalitis Tricks Everyone: A Diagnostic Challenge

Santhiya Devadas, Sin Mei Yang, Tan Huey Jing

Abstract


Anti-NMDAR encephalitis is second most commonest encephalitis after acute demyelinating encephalitis. It has been under recognised in our practice and the clinical presentation which may vary, poses a diagnostic challenge to the clinicians, especially to psychiatrists due to the prominent neuropsychiatric manifestation encompassing the disorder. This is a report of 2 cases of Anti-NMDAR encephalitis diagnosed in psychiatry ward who presented with prominent neuropsychiatric sign and symptoms. The male patient had prodromal viral flu like illness, aggressive and disorganised behaviour with visual hallucination and persecutory delusion for 2 days and subsequently developed abnormal movements. On the other hand, the lady presented with difficulties sleeping, auditory hallucinations and disorganised behaviour for 5 days. CT brain of both the patients were unrevealing. EEG was abnormal and NMDAR antibodies was detected in their CSF. The female patient had ovarian teratoma and she underwent surgical resection. Immunotherapy was initiated for both the patients. It is important to keep NMDAR encephalitis as a differential in patients presenting with acute psychiatric symptoms, poorly formed delusions, behaviour changes, abnormal movements and seizures. Early diagnosis, immediate immunotherapy and removal of the culprit malignancy is important for a better prognosis with up to 75% of patients achieving full recovery.

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Keywords


Anti-NMDAR Encephalitis; Atypical Psychotic Symptoms; Ovarian Teratoma; Immunotherapy

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