title: Anti-NMDAR encephalitis misdiagnosed as Hashimoto's encephalopathy.
abstract: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a well-defined autoimmune disorder. Hashimoto's encephalopathy (HE) is a still controversial entity, lacking definite diagnostic criteria. We described a 14-year-old-girl presenting with a clinical picture consistent with the diagnosis of anti-NMDAR encephalitis, confirmed by NMDAR antibody testing. Four years earlier, she had presented a similar episode of acute encephalopathy diagnosed as HE. Anti-NMDAR encephalitis and HE share similar clinical features so that the differential diagnosis can be difficult if specific antibodies are not tested. The correct diagnosis of anti-NMDAR encephalitis is crucial to plan the appropriate management and follow-up, namely in term of oncological screening, since it can be paraneoplastic in origin. We suggest to re-evaluate the clinical history of all subjects with previous HE diagnosis in order to evaluate the possible diagnosis of anti-NMDAR encephalitis and plan the appropriate management of these patients.
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy. Electronic address: marisol.mirabelli@gmail.com.
authors: M
authors: M
authors: Mirabelli-Badenier
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
authors: R
authors: R
authors: Biancheri
authors: Paediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors: G
authors: G
authors: Morana
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
authors: S
authors: S
authors: Fornarino
authors: Paediatric Unit, San Paolo Hospital, Savona, Italy.
authors: L
authors: L
authors: Siri
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
authors: M E
authors: ME
authors: Celle
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
authors: E
authors: E
authors: Veneselli
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors: A
authors: A
authors: Vincent
authors: Paediatric Unit, San Paolo Hospital, Savona, Italy.
authors: R
authors: R
authors: Gaggero
authors: Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
authors: M M
authors: MM
authors: Mancardi
mesh_terms: D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy; D003951:Diagnostic Errors; D004569:Electroencephalography; D004660:Encephalitis; D005260:Female; D050031:Hashimoto Disease / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000494:pharmacology*; D008279:Magnetic Resonance Imaging; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: Anti-N-methyl-D-aspartate receptor encephalitis; Epilepsy; Hashimoto encephalopathy; Neuronal surface antibodies; Paraneoplastic