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.
Nooshin Karamzadeh Dashti, M.D.
Resident, Anatomic/Clinical Pathology
Jeffrey Winters, M.D.
Consultant, Division of Transfusion Medicine
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine