title: Anti-NMDAR encephalitis mimicking HaNDL syndrome.
abstract: BACKGROUND
  Anti-NMDA receptor encephalitis typically manifests as severe multistage neuropsychiatric syndrome. However, milder or incomplete forms of the disorder have been recognised. Here, we report on a patient with anti-NMDA receptor encephalitis with a clinical phenotype mimicking the syndrome of headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL).
  
  
  METHODS
  A 67-year-old man presented with recurrent stereotyped episodes of hemianopia, aphasia and right hemiparesis accompanied by throbbing headaches as well as confusion and agitation. CSF analysis showed lymphocytic pleocytosis. Additional analysis revealed NMDA receptor IgG antibodies in the patient's CSF. Following immunotherapy, no further episodes occurred and NMDAR antibodies became undetectable. No NMDAR or other neuronal antibodies were detected in archived serum and CSF samples of 12 HaNDL patients fulfilling the current diagnostic criteria.
  
  
  CONCLUSIONS
  While anti-NMDAR encephalitis can manifest with a HaNDL-like clinical picture, HaNDL syndrome itself does not appear to be mediated by anti-NMDAR antibodies.
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Germany carsten.finke@charite.de.
authors.forename: Carsten
authors.initials: C
authors.lastname: Finke
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Annerose
authors.initials: A
authors.lastname: Mengel
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Prüss
authors.affiliation: Institut für Experimentelle Immunologie der Euroimmun AG Lübeck, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Stöcker
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meisel
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Ruprecht
mesh_terms: D000368:Aged; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D020773:Headache Disorders / Q000175:diagnosis*; D006801:Humans; D008218:Lymphocytosis / Q000134:cerebrospinal fluid / Q000175:diagnosis; D008297:Male
keywords: Anti-NMDA receptor encephalitis; antibodies; headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL)