A diagnosis you can ’t afford to miss
4 out of 5 stars Antibody-Mediated Encephalitis. Dalmau J, Graus F. N Engl J Med 2018 Mar 1;378:840-851. Reference TPR has posted before about anti-NMDA receptor encephalitis, a must-know, can’t-miss, humbling diagnosis that is distressingly easy to overlook. Although it is not a toxicologic condition, all toxicologists and emergency physicians should be thoroughly familiar with its presentation and clinical course. Let me explain why. NMDAR encephalitis often begins with behavioral changes, mood swings, and memory deficits in relatively young patients. According to this somewhat technical but excellent review, the median age is 21 years, with a 4:1 ratio of females to males. Because of the initial symptoms, patients are often diagnosed as having new-onset psychiatric disease. It is not unusual for these patients to then be treated with antipsychotic medication in an attempt to control abnormal and agitated behavior. This is where a toxicologist may be consulted. As the authors point out in this review, patients with NMDAR encephalitis seem to have increased susceptibility to developing neuroleptic malignant syndrome (NMS) after receiving antipsychotics. When these patients then develop movement disorders, autonomic instability, and altered mental status, the toxicology service is brought in to advise about the treatment of NMS. If the diagnosis of NMDAR encephalitis is not considered, the outcome can be catastrophic. As the authors of this review note “spontane...
Source: The Poison Review - Category: Toxicology Authors: Leon Gussow Tags: Medical anbitody-mediated encephalitis anti-NMDA receptor encephalitis brain on fire diagnosis Source Type: news
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