Seronegative Anti–N-Methyl-D-Aspartate Receptor Encephalitis

      We describe a case of a young woman who was admitted to a psychiatric ward with labile mood and psychosis. She developed autonomic instability and profound catatonia that was treated partially with electroconvulsive therapy (ECT). Magnetic resonance imaging (MRI) of the brain was normal, and electroencephalography (EEG) showed nonspecific findings. Her serum was negative for anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies, and her condition remained untreated. She remained symptomatic for several months and repeat serum samples were taken, paired with cerebrospinal fluid (CSF) samples. These were positive and the diagnosis of anti-NMDA encephalitis was made.
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      Linked Article

      • The Importance of Keeping in Mind the Diagnosis of N-Methyl-D-Aspartate Receptor Encephalitis
        Biological PsychiatryVol. 80Issue 4
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          We would like to draw readers’ attention to the recent case report by Murdie et al. (1). The authors described a young woman with low mood, delusions, auditory hallucinations, and catatonia, followed by tachycardia, hyperthermia, and dysphagia and possible diagnosis of autoimmune N-methyl-D-aspartate receptor (NMDAR)-antibody encephalitis. The patient had positive NMDAR autoantibodies in serum and cerebrospinal fluid (CSF), while an initial serum test was reported as negative. The authors cite this as evidence to emphasize the importance of CSF testing.
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