Must-read: Anti-NMDA Receptor Encephalitis
4.5 out of 5 stars
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential of delirium. Punja M et al. Clin Toxicol 2013 Aug 20 [Epub ahead of print]
Abstract
This important paper is a must-read, especially for toxicologists who have not heard of this under-appreciated neurological disorder. (I was not aware of it until several days ago, when I found out that a friend of a relative had received the diagnosis.) Anti-NMDA encephalitis was first described in 2005. Advanced cases often develop altered mental status, autonomic instability, increased muscle tone, and movement disorders. Since initial behavioral and cognitive changes are easily mistaken for a new psychiatric diagnosis and treated with neuroleptic medications, toxicologists are frequently called on to evaluate these patients for neuroleptic malignant syndrome (NMS). This paper describes two such patients.
Anti-NMDAR encephalitis typically affects younger patients. In one series of 100 cases, the median age was 23 years (range, 5-76 years); over 90% were female. In that series, patients presented with psychiatric symptoms or memory disorders (100%), decreased levels of consciousness (88%), dyskinesias (86%), and seizures (76%), All had antibodies in the cerebrospinal fluid against subunits of the NMDA receptor. Since these receptors are prevalent in the limbic system and the hippocampus, patients develop signs and symptoms of limbic encephalitis: memory loss, ...
Source: The Poison Review - Category: Toxicology Authors: Leon Tags: Best of TPR Medical anti-n-methyl-d-aspartate receptor anti-NMDA receptor encephalitis autoimmune neurologic Source Type: news
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