J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-302904
  • Neurological picture

Anti-NMDA-receptor encephalitis: unusual presentation of an uncommon condition

  1. Stacey L Clardy
  1. Department of Neurology, Penn State M.S. Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Stacey L Clardy, Penn State M.S. Hershey Medical Center, Department of Neurology, EC037, PO Box 859, Hershey, PA 17033-0859, USA; staceylynnclardy{at}
  1. Contributors DKR collected the data and revised the manuscript. SC conceptualised the manuscript, organised the data and wrote the manuscript.

  • Received 3 April 2012
  • Revised 3 August 2012
  • Accepted 6 August 2012
  • Published Online First 5 September 2012

A 19-year-old woman with no significant past medical history presented to the hospital after a 1-week illness. Her symptoms began with 2 days of vomiting, diarrhoea and decreased sensation in the fingertips. She subsequently developed emotional labiality and auditory hallucinations characterised by a persistent background humming. On the fifth day of her illness, she developed dysarthria and expressive aphasia. Initial examination approximately 1 week from symptom onset was significant for expressive and receptive aphasia, inattention and disorganisation, and fluctuating mental status consistent with delirium, with no obvious motor deficits. Brain MRI revealed a left medial temporal T2 hyperintensity without enhancement on FLAIR (figure 1A). Cerebrospinal fluid (CSF) revealed 129 nucleated cells with a lymphocytic predominance and no red blood cells. Extensive …

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