title: [First occurrence of an organic manic schizophreniform syndrome followed by catatonia induced by anti-NMDA-receptor encephalitis].
abstract: We report on a 39-year-old female patient who developed catatonia after there had been schizomanic symptoms in the six months before. At admission the patient exhibited catatonia, a tetraspastic syndrome and focal epileptic seizures. The cranial MRI revealed bilateral subcortical hyperintense lesions which took up contrast agent. Examination of the cerebrospinal fluid disclosed a lymphocytic pleocytosis and autochthone oligoclonal bands. In the serum autoantibodies against the NMDA-NR-1 receptor were reproducibly detected. A detailed search for a tumour was negative. In detail, we could exclude a neoplasm of the ovaries which is often present in the paraneoplastic type of anti-NMDA-receptor encephalitis. Therefore we assume an autoimmune, not paraneoplastic, encephalitis in our patient. The symptoms improved significantly after an immunosuppressive therapy - initially with glucocorticoids followed by rituximab - had been initiated. This case illustrates that an autoimmune encephalitis should be looked for when first psychotic symptoms occur.
authors.affiliation: Klinik für Neurologie, Universitätsklinikum des Saarlands, 66421 Homburg.
authors.forename: M
authors.initials: M
authors.lastname: Fousse
authors.forename: C
authors.initials: C
authors.lastname: Becker
authors.forename: K
authors.initials: K
authors.lastname: Faßbender
authors.forename: W
authors.initials: W
authors.lastname: Reith
authors.forename: H
authors.initials: H
authors.lastname: Körner
authors.forename: M
authors.initials: M
authors.lastname: Alexandrou
authors.forename: J
authors.initials: J
authors.lastname: Spiegel
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology*; D002389:Catatonia / Q000209:etiology / Q000523:psychology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D011618:Psychotic Disorders / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology*; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D000069283:Rituximab
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D016194:Receptors, N-Methyl-D-Aspartate; D000069283:Rituximab