Abstracts

Rationale: Anti-NMDA receptor encephalitis is caused by an autoimmune reaction primarily against NR1 subunit of the NMDA receptor. Anti-NMDA receptor encephalitis is potentially lethal. We present two patients with Anti-NMDA receptor encephalitis. Methods: Case report: First case - Twenty-three-year-old male presented with three weeks history of acute onset psychiatric symptoms including obsession with weight loss, agitation and hyper-religiosity He also had new onset seizure. CSF analysis was significant for 12 WBC with 97% lymphocytes and positive serum and CSF anti-NMDA receptor antibodies titer of 1:40. Appropriate treatment for anti-NMDA receptor encephalitis was started on day36 from his first clinical manifestation. He was hospitalized for 4 months with minimal improvement and ultimately required tracheostomy and peg placement. Results: Second Case - Twenty-three-year-old female presented with three weeks history of behavior changes including agitation and staring spells (new onset seizure). CSF analysis showed 426 WBC with 99% lymphocytes. She had positive similar titer of anti-NMDA receptor antibodies as patient one. Exact same treatment for patient in first case was given to this patient but on day 22 from her first clinical symptoms. Patient responded dramatically to the treatment within 2 weeks. Conclusions: CONCLUSIONS: Discussion: Most patients with anti-NMDA receptor encephalitis present in stages. The disease usually begins with psychiatric symptoms such as psychosis, anxiety, delusions, and hyper-religiosity. It then progresses to memory deficits, seizures, movement disorder, autonomic instability and decreased level of consciousness. Multi-institutional study done by Titulaer MJ et al found early treatment was one of the predictors of good outcome for anti-NMDA receptor encephalitis. Patient with anti-NMDA receptor encephalitis come in with refractory seizure and severe psychosis which usually lead patient to ICU admission. It is important to keep anti-NMDA receptor encephalitis in the list of differential diagnoses for patients presenting with new onset seizure and psychosis as early recognition and treatment makes a great difference in the prognosis among patients with anti-NMDA receptor encephalitis.