title: Early diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a young woman with psychiatric symptoms.
abstract: A previously healthy 21-year-old woman, transported to our medical emergency center for excluding organic brain disease, had undergone medical examination 9 days before for trembling in her left hand, which was caused by stress. The patient exhibited fever and strange behaviors, e.g., wandering around, babbling, and making smoking gestures; hence, psychiatric examination was performed. The patient's Glasgow Coma Scale score was 4-3-5, and involuntary movement was observed. Cerebrospinal fluid examination revealed increased cell count; hence, we suspected anti-N-methyl-d-aspartate (NMDA) receptor encephalitis. We conducted an abdominal CT scan, which revealed a neoplastic lesion with calcification in the right ovary. Early steroid pulse therapy was started. On hospital day 25, she tested positive for anti-NMDA receptor antibodies; hence, anti-NMDA receptor encephalitis and concomitant ovarian teratoma was diagnosid. She underwent right adnexectomy; subsequently, immunotherapy was performed. The patient recovered and was discharged on hospital day 105. Anti-NMDA receptor encephalitis is not uncommon; however, this disease must be considered for young encephalitis patients exhibiting psychiatric symptoms. If patients (aged ≤ 30 years) presents with encephalitis of uncertain etiology, psychiatric symptoms, seizures, movement disorders, or psychosis, clinicians should consider anti-NMDA encephalitis as a possible diagnosis. Clinical diagnosis should be waged early to ensure timely treatment.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. h.aoki@is.icc.u-tokai.ac.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Aoki
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Naoya
authors.initials: N
authors.lastname: Miura
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Tsuji
authors.forename: Youichi
authors.initials: Y
authors.lastname: Ohnuki
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Isotoshi
authors.initials: I
authors.lastname: Yamamoto
authors.forename: Hirohide
authors.initials: H
authors.lastname: Takahashi
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D001323:Autoantibodies / Q000097:blood / Q000134:cerebrospinal fluid; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D013724:Teratoma / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate