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Early diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a young woman with psychiatric symptoms.
Tokai J Exp Clin Med. 2012 Sep 20; 37(3):89-93.TJ

Abstract

A previously healthy 21-year-old woman, transported to our medical emergency center for excluding organic brain disease, had undergone medical examination 9 days before for trembling in her left hand, which was caused by stress. The patient exhibited fever and strange behaviors, e.g., wandering around, babbling, and making smoking gestures; hence, psychiatric examination was performed. The patient's Glasgow Coma Scale score was 4-3-5, and involuntary movement was observed. Cerebrospinal fluid examination revealed increased cell count; hence, we suspected anti-N-methyl-d-aspartate (NMDA) receptor encephalitis. We conducted an abdominal CT scan, which revealed a neoplastic lesion with calcification in the right ovary. Early steroid pulse therapy was started. On hospital day 25, she tested positive for anti-NMDA receptor antibodies; hence, anti-NMDA receptor encephalitis and concomitant ovarian teratoma was diagnosid. She underwent right adnexectomy; subsequently, immunotherapy was performed. The patient recovered and was discharged on hospital day 105. Anti-NMDA receptor encephalitis is not uncommon; however, this disease must be considered for young encephalitis patients exhibiting psychiatric symptoms. If patients (aged ≤ 30 years) presents with encephalitis of uncertain etiology, psychiatric symptoms, seizures, movement disorders, or psychosis, clinicians should consider anti-NMDA encephalitis as a possible diagnosis. Clinical diagnosis should be waged early to ensure timely treatment.

Authors+Show Affiliations

Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. h.aoki@is.icc.u-tokai.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23032251

Citation

Aoki, Hiromichi, et al. "Early Diagnosis of anti-N-methyl-D-aspartate Receptor Encephalitis in a Young Woman With Psychiatric Symptoms." The Tokai Journal of Experimental and Clinical Medicine, vol. 37, no. 3, 2012, pp. 89-93.
Aoki H, Morita S, Miura N, et al. Early diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a young woman with psychiatric symptoms. Tokai J Exp Clin Med. 2012;37(3):89-93.
Aoki, H., Morita, S., Miura, N., Tsuji, T., Ohnuki, Y., Nakagawa, Y., Yamamoto, I., Takahashi, H., & Inokuchi, S. (2012). Early diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a young woman with psychiatric symptoms. The Tokai Journal of Experimental and Clinical Medicine, 37(3), 89-93.
Aoki H, et al. Early Diagnosis of anti-N-methyl-D-aspartate Receptor Encephalitis in a Young Woman With Psychiatric Symptoms. Tokai J Exp Clin Med. 2012 Sep 20;37(3):89-93. PubMed PMID: 23032251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a young woman with psychiatric symptoms. AU - Aoki,Hiromichi, AU - Morita,Seiji, AU - Miura,Naoya, AU - Tsuji,Tomoatsu, AU - Ohnuki,Youichi, AU - Nakagawa,Yoshihide, AU - Yamamoto,Isotoshi, AU - Takahashi,Hirohide, AU - Inokuchi,Sadaki, Y1 - 2012/09/20/ PY - 2012/07/02/received PY - 2012/07/30/accepted PY - 2012/10/4/entrez PY - 2012/10/4/pubmed PY - 2013/4/20/medline SP - 89 EP - 93 JF - The Tokai journal of experimental and clinical medicine JO - Tokai J Exp Clin Med VL - 37 IS - 3 N2 - A previously healthy 21-year-old woman, transported to our medical emergency center for excluding organic brain disease, had undergone medical examination 9 days before for trembling in her left hand, which was caused by stress. The patient exhibited fever and strange behaviors, e.g., wandering around, babbling, and making smoking gestures; hence, psychiatric examination was performed. The patient's Glasgow Coma Scale score was 4-3-5, and involuntary movement was observed. Cerebrospinal fluid examination revealed increased cell count; hence, we suspected anti-N-methyl-d-aspartate (NMDA) receptor encephalitis. We conducted an abdominal CT scan, which revealed a neoplastic lesion with calcification in the right ovary. Early steroid pulse therapy was started. On hospital day 25, she tested positive for anti-NMDA receptor antibodies; hence, anti-NMDA receptor encephalitis and concomitant ovarian teratoma was diagnosid. She underwent right adnexectomy; subsequently, immunotherapy was performed. The patient recovered and was discharged on hospital day 105. Anti-NMDA receptor encephalitis is not uncommon; however, this disease must be considered for young encephalitis patients exhibiting psychiatric symptoms. If patients (aged ≤ 30 years) presents with encephalitis of uncertain etiology, psychiatric symptoms, seizures, movement disorders, or psychosis, clinicians should consider anti-NMDA encephalitis as a possible diagnosis. Clinical diagnosis should be waged early to ensure timely treatment. SN - 2185-2243 UR - https://www.unboundmedicine.com/medline/citation/23032251/Early_diagnosis_of_anti_N_methyl_D_aspartate_receptor_encephalitis_in_a_young_woman_with_psychiatric_symptoms_ L2 - http://mj-med-u-tokai.com/pdf/370307.pdf DB - PRIME DP - Unbound Medicine ER -