Citation

Dubey S, Ghosh R, Dubey MJ, Sengupta S, Benito-León J, Ray BK. J. Neuroimmunol. 2020; 347: e577329.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.jneuroim.2020.577329

PMID

32745805

PMCID

PMC7374132

Abstract

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is one of the most common causes of autoimmune encephalitis. Both movement disorders and neuropsychiatric manifestations are considered core features of anti-NMDAR encephalitis. Strong clinical suspicion, along with NMDAR antibody positivity in paired sample of serum and cerebrospinal fluid, with supportive MRI changes clinch diagnosis in majority. We herein report a case of a middle-aged woman with subacute behavioral abnormalities, which were so severe that forced her to attempt suicide. Hemichorea and dystonia, which appeared later in course, are not previously reported movement disorders in combination in anti-NMDAR encephalitis. Further, magnetic resonance imaging showed bilateral thalamic hyperintensities with diffusion restriction, which are in turn not described in this entity. After amalgamation of history, especially the presence of neuropsychiatric symptoms, clinical features, physical examination, and investigations, the diagnosis of anti-NMDAR encephalitis could be established. Our case not only highlights that the combination of hemichorea and dystonia can be features of anti-NMDAR encephalitis, but adds novelty by bilateral symmetric thalamic changes.

Language: en

Keywords

Acute Disease; Adult; Anti-N-methyl-d-aspartate receptor encephalitis; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Chorea; Dystonia; Female; Humans; Immunoglobulins, Intravenous; Movement disorders; Neuropsychiatric manifestations; Psychotic Disorders; Thalamus