Medicina Fluminensis, Vol. 62 No. 1, 2026.
Studija slučaja
https://doi.org/10.21860/medflum2026_343567
Anti-NMDA Receptor Encephalitis in an Elderly Patient – A Case Report
Ivona Levak
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
*
Marta Ovčar
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Ana Novaković
; Vojnomedicinska akademija Beograd, Klinika za neurologiju, Beograd, Srbija
Ivana Stanković Matić
; Vojnomedicinska akademija Beograd, Klinika za neurologiju, Beograd, Srbija; Sveučilište u Rijeci, Medicinski fakultet, Zavod za medicinsku biologiju i genetiku, Rijeka, Hrvatska
* Dopisni autor.
Sažetak
Aim: To present a case of a patient with anti-NMDA receptor encephalitis and highlight the importance of recognizing this disease by going through the entire differential diagnostic process from the patient’s first visit to the physician. Case report: A 66-year-old female patient was admitted to the neurology department due to newly developed epileptic seizures. Based on the magnetic resonance imaging (MRI) findings of the brain, it was believed to be symptomatic epilepsy resulting from ischemic brain disease, and appropriate antiepileptic therapy was initiated. After seven months, neuropsychological testing was performed due to subjective complaints of memory loss and anxiety. The testing revealed impairments in visuoconstructive functions with right-sided visuospatial neglect, with no changes in the follow-up neuroimaging findings, which corresponded to the previously established diagnosis. After five months, the patient was re-hospitalized due to a series of epileptic seizures, accompanied by worsening speech and behavioural changes. In addition to antiepileptic therapy, further investigations were conducted to clarify the aetiology of the polymorphic symptoms. Standard electroencephalogram (EEG) findings indicated encephalopathy. Positive oligoclonal bands were found in the cerebrospinal fluid through immunohistochemical staining, and screening for the presence of paraneoplastic antibodies showed a positive finding in the cerebrospinal fluid (CSF) for elevated titres of anti-NMDAR antibodies. Based on the clinical picture and additional test results, it was confirmed that the patient had autoimmune encephalitis mediated by anti-NMDAR antibodies. The patient was treated with multimodal immunosuppressive therapy with a positive therapeutic response in cognitive status. Conclusion: Although anti-NMDA receptor encephalitis was initially described as part of a paraneoplastic syndrome, it is now one of the most common causes of non-viral encephalitis. The speed of recognition and appropriate treatment are crucial for survival and return to functionality; therefore, it is important to sensitize young clinicians to suspect this disease, especially in older patients.
Ključne riječi
autoimmune encephalitis; electroencephalogram; epileptic seizures; NMDA receptor; paraneoplastic syndromes
Hrčak ID:
343567
URI
Datum izdavanja:
1.3.2026.
Posjeta: 263 *