Abstract

We describe a young patient who presented with a subacute encephalopathy and dyskinesias, together with video footage of the acute illness and convalescent period. A 19-year-old woman presented with a 3-week history of insomnia and paranoia, progressing to visual and auditory hallucinations and eventually frank psychosis. She was referred to neurology services after developing episodes of oral mutilation and involuntary facial movements. On admission she was noted to have repetitive involuntary chewing and swallowing movements. She became increasingly agitated and developed seizures, requiring sedation and ventilation. Preliminary investigations including routine blood tests, viral serology, whole body CT, MRI brain and inflammatory markers were normal. She had a CSF lymphocytosis and an EEG suggested complex partial status epilepticus. Anti-N-methyl-d-aspartate (NMDA) receptors antibodies were strongly positive. Following treatment with steroids and plasma exchange, she made an excellent recovery, and was discharged 12 weeks after the onset of symptoms with mild cognitive difficulties only. Anti-NMDA receptor encephalitis is an increasingly recognised, treatable immune-mediated encephalopathy. It is typically seen in young female patients presenting with neuropsychiatric problems, dyskinesias and seizures. There is a recognised association with malignancy, particularly ovarian teratomas. Prognosis is good with 75% making a full recovery or being left with only mild deficits.