Articles, Issue 3/2022

Autoimmune anti-NMDA-receptor Encephalitis – the Difficult Diagnostic Pathway

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L. Dimitrova, T. Paneva, L. Bozadzhieva, P. Pavlov, G. Peev, P. Bozhilova, Iv. Litvinenko, I. Ivanov, D. Iliev


Abstract

Anti-N-methyl-D-aspartate-receptor antibody encephalitis is a disorder, characterized by psychotic production, loss of consciousness, seizures and autonomic dysfunction. The following case presents an adolescent with headache, weakness, hallucinations, dynamic consciousness, psychomotor agitation, generalized tonic-clonic seizures and autonomic imbalance. Magnetic resonance imaging of central nervous system, electroencephalogram and spinal fluid investigations (biochemistry, microbiology and electrophoresis) don’t show pathologic changes at first. Diagnosis is based on finding the pathognomonic antibodies in blood and cerebrospinal fluid after secondary investigation. Therapy with intravenous corticosteroids and immunoglobulin is started and followed by significant clinical improvement.

Keywords: N-methyl-D-aspartate, encephalitis, hallucinations, generalized tonic-clonic seizures, cerebrospinal fluid, antibodies

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Address for correspondence:

SBALDB “Prof. D-r Ivan Mitev” – Sofia
11, “Acad. I. Geshov”, Blvd.
1606, Sofia, Bulgaria
e-mail: dimitrova@gmail.com