Abstract
Anti-NMDA receptor encephalitis is an acute form of brain inflammation that is potentially lethal but has a high probability for recovery with treatment. Although the clinical picture of anti-NMDAR encephalitis is usually recognizable due to its relatively well-known symptoms, the disorder can sometimes present itself in an unpredictable and atypical way. In this case report, we wish to present the influence of different delay times prior to the establishment of diagnosis. Thus, our first patient was diagnosed with anti-NMDAR encephalitis 4 years after the initial symptoms, the second one after 8 years, and the third one after 13 months. The outcomes of the three presented patients indicate the importance of being aware of many clinical presentations of this disorder, as its early diagnosis greatly affects the outcome and may reduce permanent damage, especially in cognitive functions.
Similar content being viewed by others
References
Barry H, Hardiman O, Healz DG, Keogan M, Moroney J, Molnar PP, Cotter DR, Murphy KC (2011) Anti NMDA receptor encephalits: an important differential diagnosis in psychosis. Br J Psychiatry 199(6):508–509. https://doi.org/10.1192/bjp.bp.111.092197
Barry H, Byrne S, Barrett E, Murphy KC, Cotter DR (2015) Anti-N-methyl D-aspartate receptor encephalitis: review of clinical presentation, diagnosis and treatment. BJPsych Bull 39(1):19–23. https://doi.org/10.1192/pb.bp.113.045518
Bien CG, Elger CE (2007) Limbic encephalitis: a cause of temporal lobe epilepsy with onset in adult life. Epilepsy Behav 10(4):529–538
Chapman MR, Vause HE (2011) Anti NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry 168(3):245–251. https://doi.org/10.1176/appi.ajp.2010.10020181
Dalmau J, Gleichman AJ, Huges EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7(12):1091–1098. https://doi.org/10.1016/S1474-4422(08)70224-2
Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10(1):63–74. https://doi.org/10.1016/S1474-4422(10)70253-2
de Montmollin E, Demeret S, Brulé N, Conrad M, Dailler F, Lerolle N, Navellou JC, Schwebel C, Alves M, Cour M, Engrand N, Tonnelier JM, Maury E, Ruckly S, Picard G, Rogemond V, Magalhaes É, Sharshar T, Timsit JF, Honnorat J, Sonneville R (2017) Anti-N-methyl-D-aspartate receptor encephalitis in adult patients requiring intensive care. Am J Respir Crit Care Med 195(4):491–499. https://doi.org/10.1164/rccm.201603-0507OC
Finke C, Kopp UA, Pruss H, Dalmau J, Wandinger K-P, Ploner CJ (2018) Cognitive deficits following anti-NMDA receptor encephalitis. J Clin Exp Neuropsychol 40(3):234–252. https://doi.org/10.1080/13803395.2017.1329408
Gabilondo I, Saiz A, Galan L, González V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Viñals M, Villoslada P, Graus F (2011) Analysis of relapses in anti-NMDAR encephalitis. Neurology 77(10):996–999. https://doi.org/10.1212/WNL.0b013e31822cfc6b
Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15(4):391–404. https://doi.org/10.1016/S1474-4422(15)00401-9
Herken J, Pruss H (2017) Red flags: clinical signs for identifying autoimmune encephalits in psychiatric patients. Front Psychiatry 8:25. https://doi.org/10.3389/fpsyt.2017.00025
Irani SR, Bera L, Waters P, González V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Viñals M, Villoslada P, Graus F (2011) N-methyl-D-asparatate receptor (NMDAR) encephalits: temporal progression of clinical and paraclinical observations in a predominantly non paraneoplastic disorders of both sexes. Neurology 77(10):996–999. https://doi.org/10.1212/WNL.0b013e31822cfc6b
Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J (2013) Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-d-aspartate receptor encephalitis. JAMA Neurol 70(9):1133–1139
Lejuste F, Thomas L, Picard G, Desestret V, Ducray F, Rogemond V, Psimaras D, Antoine JC, Delattre JY, Groc L, Leboyer M, Honnorat J (2016) Neuroleptic intolerance in patients with anti-NMDAR encephalitis. Neurol Neuroimmunol Neuroinflamm 3(5):e280. https://doi.org/10.1212/NXI.0000000000000280
Lergiel S, Mourvillier B, Bele N, Amro J, Fouet P, Manet P, Hilpert F (2008) Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med 34(3):476–480
McKneon GL, Robinson GA, Ryan AE, Blum S, Gillis D, Finke C, Scott JG (2018) Cognitive outcomes following anti N-methyl-D-aspratate receptor encephaltis: a systematic review. J Clin Exp Neuropsychol 40(3):234–252. https://doi.org/10.1080/13803395.2017.1329408
Sutter R, Marsch S, Fuhr P, Rüegg S (2013) Mortality and recovery from refractory status epilepticus in the intensive care unit: a 7-year observational study. Epilepsia 54(3):502–511
Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-N-methyl-D-aspratate (NMDA) receptor encephalitis: a cohort study. Lancet Neurol 12:157–165. https://doi.org/10.1016/S1474-4422(12)70310-1
Venkatesan A, Adatia K (2017) Anti-NMDA-receptor encephalitis: from bench to clinic. ACS Chem Neurosci 8(12):2586–2595. https://doi.org/10.1021/acschemneuro.7b00319
Author information
Authors and Affiliations
Contributions
VS and ZPG prepared the case report. ZPG, SN, and VS are consultant neurologist responsible for the care of the patients. MS has been consulted as a specialist in infectious diseases and intensive medicine. DB and FD are responsible for the reference managing and preparing the text for submission.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Sulentic, V., Petelin Gadze, Z., Derke, F. et al. The effect of delayed anti-NMDAR encephalitis recognition on disease outcome. J. Neurovirol. 24, 638–641 (2018). https://doi.org/10.1007/s13365-018-0648-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13365-018-0648-y