Anti-NMDA Encephalitis

Anti-NMDA receptor encephalitis 

  • autoimmune encephalitis, paraneoplastic encephalitis
  • associated with tumors in 60% of cases (usually ovarian teratoma)
  • first described in 2005, anti-NMDAR antibodies discovered in 2007

Anti-NMDA receptor encephalitis is an immune-mediated syndrome predominantly seen in young females.  Symptoms include psychiatric changes, autonomic dysfunction and other neurologic findings.  It is commonly associated with mature ovarian teratomas.

There is a need for increased awareness and diagnostic suspicion for anti-NMDA encephalitis in patients with suspected encephalitis of unknown etiology.  Early intervention significantly affects outcome.


  1. Prodromal – nonspecific (fever, headache, nausea)
  2. Psychotic – emotional disturbances, cognitive fluctuations, paranoia, delusions, amnesia, hallucinations
  3. Unresponsive / hyperkinetic – catatonia (cataplexy, mutism, rigidity), abnormal involuntary movements (orolingual dyskinesia), seizures, decreased level of consciousness, autonomic instability, sleep disturbances
  4. Recovery – gradual and usually complete

Treatment for this condition includes supportive care, considering surgical resection when appropriate and immune-modulating therapies.


This algorithm was taken from an abstract presented at the SCCM 45th Critical Care Congress by McLatchy, et al of Hofstra Northwell School of Medicine.

2016-02-24 07.27.46.jpg





Abstract.  Anti-N-methyl-D-aspartate Receptor Encephalitis: An underrecognized, Treatable Disease.  McLatchy, J. et al.  SCCM 2016 45th Critical Care Congress. February 19-24, 2016, Orlando, Florida.


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