Difference between revisions of "Anti-NMDA receptor encephalitis"

(Created page with "Anti-NMDA receptor encephalitis: * generally, affects younger individuals (95% younger than 45, 37% younger than 18) * Typically, presentation begins with abnormal behavior (...")
 
 
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Anti-NMDA receptor encephalitis:
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* Generally, affects younger individuals (95% younger than 45, 37% younger than 18)
* generally, affects younger individuals (95% younger than 45, 37% younger than 18)
 
 
* Typically, presentation begins with abnormal behavior (psychosis, delusions, hallucinations, agitation, aggression, or catatonia) with irritability and insomnia
 
* Typically, presentation begins with abnormal behavior (psychosis, delusions, hallucinations, agitation, aggression, or catatonia) with irritability and insomnia
 
* Over weeks followed by speech dysfunction, dyskinesias, memory deficits, autonomic stability, and decreased level of consciousness.  
 
* Over weeks followed by speech dysfunction, dyskinesias, memory deficits, autonomic stability, and decreased level of consciousness.  
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Patients with relapsing symptoms s/p herpes simplex encephalitis should also be tested for NMDA receptor antibodies, which is an autoimmune reaction affecting 20% of patients with HSE, manifesting as either new onset choreoathetosis or psychiatric symptoms a few weeks after viral infection.
 
Patients with relapsing symptoms s/p herpes simplex encephalitis should also be tested for NMDA receptor antibodies, which is an autoimmune reaction affecting 20% of patients with HSE, manifesting as either new onset choreoathetosis or psychiatric symptoms a few weeks after viral infection.
  
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==Diagnosis==
  
'''Diagnosis'''
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''Diagnostic criteria for '''probable''' anti-NMDA receptor encephalitis''
  
''Diagnostic criteria for probable anti-NMDA receptor encephalitis''
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# Rapid onset (<3 months) of at least 4 of the 6 following major groups of symptoms:
 
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## Abnormal (psychiatric) behavior or cognitive dysfunction
1) Rapid onset (<3 months) of at least 4 of the 6 following major groups of symptoms:
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## Speech dysfunction (pressured, verbal reduction, mutism)
 
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## Seizures
:a. Abnormal (psychiatric) behavior or cognitive dysfunction
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## Movement disorder, dyskinesias, or rigidity/abnormal postures
 
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## Decreased level of consciousness
:b. Speech dysfunction (pressured, verbal reduction, mutism)
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## Autonomic dysfunction or central hypoventilation
 
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# At least one of the following laboratory study results:
:c. Seizures
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## Abnormal EEG (focal or diffuse slow or disorganized activity, epileptic activity, or extreme delta brush)
 
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## CSF with pleocytosis or oligoclonal bands
:d. Movement disorder, dyskinesias, or rigidity/abnormal postures
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# Reasonable exclusion of other disorders
 
 
:e. Decreased level of consciousness
 
 
 
:f. Autonomic dysfunction or central hypoventilation
 
 
 
2) At least one of the following laboratory study results:
 
 
 
:a. Abnormal EEG (focal or diffuse slow or disorganized activity, epileptic activity, or extreme delta brush)
 
 
 
:b. CSF with pleocytosis or oligoclonal bands
 
 
 
3) Reasonable exclusion of other disorders
 
  
  
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''Diagnostic criteria for definite anti-NMDA receptor encephalitis''
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''Diagnostic criteria for '''definite''' anti-NMDA receptor encephalitis''
 
 
1) Diagnosis can be made in the presence of one or more of the six major groups of symptoms and IgG anti-GluN1 antibodies (CSF), after reasonable exclusion of other disorders
 
 
 
  
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# Diagnosis can be made in the presence of one or more of the six major groups of symptoms and IgG anti-GluN1 antibodies (CSF), after reasonable exclusion of other disorders
  
 
== References ==
 
== References ==
  
 
Graus, F. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 15, 391–404 (2016). https://pubmed.ncbi.nlm.nih.gov/26906964/
 
Graus, F. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 15, 391–404 (2016). https://pubmed.ncbi.nlm.nih.gov/26906964/

Latest revision as of 13:52, 29 June 2021

  • Generally, affects younger individuals (95% younger than 45, 37% younger than 18)
  • Typically, presentation begins with abnormal behavior (psychosis, delusions, hallucinations, agitation, aggression, or catatonia) with irritability and insomnia
  • Over weeks followed by speech dysfunction, dyskinesias, memory deficits, autonomic stability, and decreased level of consciousness.


Patients with relapsing symptoms s/p herpes simplex encephalitis should also be tested for NMDA receptor antibodies, which is an autoimmune reaction affecting 20% of patients with HSE, manifesting as either new onset choreoathetosis or psychiatric symptoms a few weeks after viral infection.

Diagnosis

Diagnostic criteria for probable anti-NMDA receptor encephalitis

  1. Rapid onset (<3 months) of at least 4 of the 6 following major groups of symptoms:
    1. Abnormal (psychiatric) behavior or cognitive dysfunction
    2. Speech dysfunction (pressured, verbal reduction, mutism)
    3. Seizures
    4. Movement disorder, dyskinesias, or rigidity/abnormal postures
    5. Decreased level of consciousness
    6. Autonomic dysfunction or central hypoventilation
  2. At least one of the following laboratory study results:
    1. Abnormal EEG (focal or diffuse slow or disorganized activity, epileptic activity, or extreme delta brush)
    2. CSF with pleocytosis or oligoclonal bands
  3. Reasonable exclusion of other disorders


Diagnosis can also be made in the presence of three of the above groups of symptoms accompanied by a systemic teratoma.


Diagnostic criteria for definite anti-NMDA receptor encephalitis

  1. Diagnosis can be made in the presence of one or more of the six major groups of symptoms and IgG anti-GluN1 antibodies (CSF), after reasonable exclusion of other disorders

References

Graus, F. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 15, 391–404 (2016). https://pubmed.ncbi.nlm.nih.gov/26906964/