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December 18, 2013: Anti-NMDA Receptor Encephalitis

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December 18, 2013

Anti-NMDA receptor encephalitis is a paraneoplastic disorder which presents with or without underlying malignancy and was originally described in females with ovarian teratoma. Patients present with a viral-like syndrome that often progresses to include prominent psychiatric manifestations of bizarre behavior, seizures, autonomic instability, and language dysfunction (1). Workup reveals CSF pleocytosis and antibodies to the NR1 subunit of the NMDA receptor. MRI and EEG findings can be variable although extreme "delta brush" pattern has been reported (2). Treatment includes tumor resection and immunosuppression. Recovery may take up to 18 months. 

References

  1. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7:1091.
  2. Schmitt SE, Pargeon K, Frechette ES, et al. 'Extreme Delta Brush': a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012; 79: 1094-1100.

Submitted by: Shila Azodi, MD; Resident Physician, Department of Neurology, University of Texas Southwestern, Austin, TX

Dr. Azodi reports no disclosures

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