Anti-NMDA receptor encephalitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] AE Dheeraj Makkar, M.D.[2]

History

The most common symptoms of Anti-NMDA receptor encephalitis include Neuropsychiatric Manifestations, Neurological Symptoms, Altered Consciousness and .

1. Neuropsychiatric Manifestations: The patient may exhibit behavioral changes, mood disturbances, including irritability, anxiety, or depression. They may also experience hallucinations both auditory and visual and exhibit signs of psychosis such as delusions or disorganized thinking. These symptoms are often mistaken for primary psychiatric disorders initially.

2. Neurological Symptoms: The patient may develop seizures, which can manifest as generalized convulsions or focal seizures involving specific body parts. They may also experience abnormal movements such as dyskinesias (involuntary, repetitive movements) or dystonia (sustained muscle contractions causing twisting or repetitive movements). Speech problems, such as slurred speech or difficulty finding words, may also be present. Autonomic dysregulation can manifest as changes in blood pressure, heart rate, or body temperature.

3. Altered Consciousness: As the disease progresses, the patient's level of consciousness may decrease, leading to confusion, disorientation, or even coma. Catatonia, a state of immobility or unresponsiveness, may occur. Hypoventilation, characterized by shallow or irregular breathing, can also be observed. Abnormal movements, such as stereotypical or repetitive motions, may be present.

4. Varied Time Frame: The symptoms typically have a subacute onset, gradually worsening over weeks or months. The duration of symptoms can vary, and early recognition is crucial for timely intervention and treatment.

Symptoms

Anti-NMDAR encephalitis manifests as a condition that manifests in stages of progressive disease and recovery.

• The majority of patients exhibit five phases of clinical presentation: a prodromal stage, psychotic and/or seizure phase, unresponsive and/or catatonic phase, hyperkinetic phase, and gradual recovery phase.

Prodromal Features occur mainly in children and include:

• Fever,
• Headache,
• Rhinitis,
• Vomiting,
• Diarrhea

Other features are:

Symptoms

Psychiatric symptoms

Neurologic symptoms

anxiety, paranoia, fear , psychosis mania insomnia

Movement Disorder : Orofacial dyskinesis are characterized by motions such as Chewing, tongue protrusion, lip smacking, and facial grimacing Pelvic thrusting, pseudo-piano playing gestures, and extremity writhing Oculogyric crisis Dystonia Autonomic features: Tachycardia, hypertension, and hyperthermia Less commonly hypersalivation, urinary incontinence Seizures: Partial and generalized seizures, as well as status epilepticus, are possible, but partial seizures tend to predominate. Unexplained new onset epilepsy in young women Cognitive problems Short-term memory loss Diminished verbal output, echolalia, echopraxia, mutism.

Anti-NMDAR encephalitis has also been documented in a female adolescent with severe longitudinal myelitis and optic neuritis mimicking neuromyelitis optica and repeated relapses.