title: Profound Autonomic Instability Complicated by Multiple Episodes of Cardiac Asystole and Refractory Bradycardia in a Patient with Anti-NMDA Encephalitis.
abstract: Anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) is autoimmune encephalitis primarily affecting young adults and children. First described about a decade ago, it frequently manifests as a syndrome that includes progressive behavioral changes, psychosis, central hypoventilation, seizures, and autonomic instability. Although cardiac arrhythmias often accompany anti-NMDARE, the need for long-term electrophysiological support is rare. We describe the case of NMDARE whose ICU course was complicated by progressively worsening episodes of tachyarrhythmia-bradyarrhythmia and episodes of asystole from which she was successfully resuscitated. Her life-threatening episodes of autonomic instability were successfully controlled only after the placement of a permanent pacemaker during her ICU stay. She made a clinical recovery and was discharged to a skilled nursing facility after a protracted hospital course.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN 37212, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Mehr
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Vanderbilt University, Nashville, TN 37212, USA.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Neeley
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN 37212, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wiley
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Vanderbilt University, Nashville, TN 37212, USA.
authors.forename: Avinash B
authors.initials: AB
authors.lastname: Kumar