PathWays Case Study: December 1

A 24-year-old female college student presents to the ER with anxiety, confusion, psychomotor agitation, acute suicidal ideation, and reported seizure. There is prior history of bipolar mood disorder. Head CT scan and MRI are normal. EEG shows nearly continuous right posterior focal seizures with some generalization to the left hemisphere. Antibody work up for autoimmune encephalitis revealed anti-N-methyl-D-aspartate receptor antibodies (NMDAR antibodies). Therapy with intravenous corticosteroids, IVIG, and plasma exchange is begun with improvement in seizure activity, neurology symptoms, and psychiatric symptoms.

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Karamzadeh Dashti_Nooshin_13JU

Nooshin Karamzadeh Dashti, M.D.
Resident, Anatomic/Clinical Pathology
Mayo Clinic

 

 

 

Jeffrey Winters, M.D.

Jeffrey Winters, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

Excellent write up to the case with good references , educative indeed

Thank You. Hope to see such a case not often.
But it would be on interest to me, wether this 24 year old female was on contraception, if yes, since when and what kind of medication. Also any else premedication would be interesting and the way of nutricion: wether she is a high rate meat-consumer especially and what about her weight (existing obesity?)
Thank You. Kind regards gsw

Great case: thanks!

Excellent case study! How common is this condition? Is it always associated with seizure activity, or can it present with only psychological symptoms?

Great case! Thank you.

Dr Sweilem, the information that you requested is not available to us. As far as I am aware from my review of the literature, there is no association between anti-NMDAR encephalitis and oral contraceptives, obesity, or diet.

Mr Bach, thank you for your questions. In regards to your question about seizures, not all patients have seizures and it can present with only psychiatric symptoms. Anti-NMDAR accounts for 4%of cases of encephalitis. Anti-NMDAR encephalitis is the second most common cause of autoimmune encephalitis after ADEM. Overall, autoimmune conditions are a small percentage of causes of encephalitis so this is a rare condition but as indicated, important to recognize. I would refer you to the article by Dalmu referenced in the case for a very good review of this entity.

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