Anti-N-methyl-D-aspartate receptor antibodies: A potentially treatable cause of encephalitis in the intensive care unit
- 1 February 2010
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 38 (2), 679-682
- https://doi.org/10.1097/ccm.0b013e3181cb0968
Abstract
OBJECTIVE: To report the occurrence of an unusual neurologic disorder requiring admission to the intensive care unit. DESIGN: Analysis of an observational cohort study of 31 patients with encephalitis admitted over a 4-yr period. SETTING: Neurologic intensive care unit in a tertiary referral center. PATIENTS: We identified N-methyl-D-aspartate receptor antibodies in six patients (two male and four female). All seropositive patients presented with a psychiatric prodrome, before developing seizures and obtundation requiring intensive care unit admission. They exhibited limb and truncal stereotypies and orofacial dyskinesias upon weaning sedation. Two patients had ovarian tumors. INTERVENTIONS: Patients were treated with sedation, antiepileptic drugs, and immunotherapy. One patient received a magnesium infusion and ketamine. MEASUREMENTS AND MAIN RESULTS: N-methyl-D-aspartate receptor antibodies were identified in serum samples by an immunofluorescent cell-based assay. Three patients made a good but slow recovery; two were left with severe neurologic deficits; and one died after return to the referring hospital. These patients accounted for approximately 20% of all patients admitted with encephalitis to this referral center. CONCLUSIONS: N-methyl-D-aspartate receptor antibodies should be tested in patients with hyperkinetic encephalitis and neuropsychiatric prodrome admitted to the intensive care unit. The disorder is probably not rare and is potentially treatableKeywords
This publication has 5 references indexed in Scilit:
- Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodiesThe Lancet Neurology, 2008
- The distinctive movement disorder of ovarian teratoma‐associated encephalitisMovement Disorders, 2008
- Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitisJournal of Neurology, Neurosurgery & Psychiatry, 2008
- Anti-NMDA receptor encephalitis in JapanNeurology, 2008
- Paraneoplastic anti–N‐methyl‐D‐aspartate receptor encephalitis associated with ovarian teratomaAnnals of Neurology, 2007