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Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? A Case Report.
J Psychiatr Pract. 2019 Sep; 25(5):383-390.JP

Abstract

Encephalitis related to antibodies against the N-methyl-D-aspartate receptor (NMDAr) is a recently described clinical entity in which IgG autoantibodies against the NR1 subunit of the NMDAr lead to the appearance of complex neuropsychiatric symptoms. As psychiatric symptoms predominate in early stages, anti-NMDAr encephalitis is frequently mistaken as a primary psychiatric disorder which delays treatment and has serious consequences for patients. This report presents the case of a 24-year-old woman with a subacute onset of psychotic and catatonic symptoms in whom current diagnostic criteria for probable anti-NMDAr encephalitis were not fulfilled. On the basis of the red flags that have been proposed to raise suspicion of anti-NMDAr encephalitis, a study of fluorodeoxyglucose positron emission tomography was requested and demonstrated bilateral occipital hypometabolism consistent with clinical suspicion of anti-NMDAr encephalitis. Once the appropriate treatment was established, the patient recovered completely. This case supports the need to maintain clinical suspicion of anti-NMDAr encephalitis, even when conventional diagnostic tests have been normal. Psychiatrists should be familiar with this entity to promote timely diagnosis and prompt treatment.

Authors+Show Affiliations

BAYLISS: Departments of Neuropsychiatry and Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico RESTREPO-MARTÍNEZ, ESPINOLA-NADURILLE: Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico DUARTE: Department of Psychiatry of the Psychiatric Hospital "Dr. Rafael Serrano," Puebla, Mexico BORJA: Department of Psychiatry of the National Institute of Psychiatry "Ramón de la Fuente," Mexico City, Mexico.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31505524

Citation

Bayliss, Leo, et al. "Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? a Case Report." Journal of Psychiatric Practice, vol. 25, no. 5, 2019, pp. 383-390.
Bayliss L, Restrepo-Martínez M, Duarte A, et al. Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? A Case Report. J Psychiatr Pract. 2019;25(5):383-390.
Bayliss, L., Restrepo-Martínez, M., Duarte, A., Borja, C. C., & Espinola-Nadurille, M. (2019). Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? A Case Report. Journal of Psychiatric Practice, 25(5), 383-390. https://doi.org/10.1097/PRA.0000000000000412
Bayliss L, et al. Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? a Case Report. J Psychiatr Pract. 2019;25(5):383-390. PubMed PMID: 31505524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are We Missing Subtle Forms of Anti-N-Methyl-D-Aspartate Encephalitis With the Current Diagnostic Approach? A Case Report. AU - Bayliss,Leo, AU - Restrepo-Martínez,Miguel, AU - Duarte,Alfonso, AU - Borja,Cesar C, AU - Espinola-Nadurille,Mariana, PY - 2019/9/11/entrez PY - 2019/9/11/pubmed PY - 2020/6/20/medline SP - 383 EP - 390 JF - Journal of psychiatric practice JO - J Psychiatr Pract VL - 25 IS - 5 N2 - Encephalitis related to antibodies against the N-methyl-D-aspartate receptor (NMDAr) is a recently described clinical entity in which IgG autoantibodies against the NR1 subunit of the NMDAr lead to the appearance of complex neuropsychiatric symptoms. As psychiatric symptoms predominate in early stages, anti-NMDAr encephalitis is frequently mistaken as a primary psychiatric disorder which delays treatment and has serious consequences for patients. This report presents the case of a 24-year-old woman with a subacute onset of psychotic and catatonic symptoms in whom current diagnostic criteria for probable anti-NMDAr encephalitis were not fulfilled. On the basis of the red flags that have been proposed to raise suspicion of anti-NMDAr encephalitis, a study of fluorodeoxyglucose positron emission tomography was requested and demonstrated bilateral occipital hypometabolism consistent with clinical suspicion of anti-NMDAr encephalitis. Once the appropriate treatment was established, the patient recovered completely. This case supports the need to maintain clinical suspicion of anti-NMDAr encephalitis, even when conventional diagnostic tests have been normal. Psychiatrists should be familiar with this entity to promote timely diagnosis and prompt treatment. SN - 1538-1145 UR - https://www.unboundmedicine.com/medline/citation/31505524/Are_We_Missing_Subtle_Forms_of_Anti_N_Methyl_D_Aspartate_Encephalitis_With_the_Current_Diagnostic_Approach_A_Case_Report_ L2 - https://doi.org/10.1097/PRA.0000000000000412 DB - PRIME DP - Unbound Medicine ER -