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.
- Prodromal – nonspecific (fever, headache, nausea)
- Psychotic – emotional disturbances, cognitive fluctuations, paranoia, delusions, amnesia, hallucinations
- Unresponsive / hyperkinetic – catatonia (cataplexy, mutism, rigidity), abnormal involuntary movements (orolingual dyskinesia), seizures, decreased level of consciousness, autonomic instability, sleep disturbances
- 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.
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.