Neuropsychiatric clinical presentation of autoimmune encephalitis by antibodies against R-NMDA, report of a case

Abstract

Background:

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder in the central nervous system, associated with antibodies that are directly against the NR1 subunit of the NMDA receptor.

The case:

31-year-old female, professional, with one month of evolution, presents with severe headache, difficulty in accommodating the eye muscles, irritability, agitation, hyperactivity, insomnia, drowsiness, signs of frontal release, glabellar and hoffman signs, and also has fever, cardiac dysautonomia, 17 thousand leukocytes, MRI with vascular subcortical demyelination, no tumors or hydrocephalus. Lumbar puncture was performed with only positive R-NMDA, step therapy is used according to the disease and complementary imaging studies.

Conclusión:

The incidence in this disease has presented an increase in the last 10 years according with the cases reported, the algorithm of encephalitis and with the biological marker. This entity constitutes 21% of the autoimmune encephalitis and approximately the 50% of the origin is unknown until now. Is commonly presented in young woman, it is a difficult diagnosis and carries a high prevalence of neurological sequelae in cases that are not diagnosed or late diagnosed and therefore provide them with a multidisciplinary management and a treatment on accorded with the disease. 

Received: 10/04/2021
Aceepted: 15/05/2021