Conference paper
ANTI-NMDA ENCEPHALITIS IN THE ACUTE SETTING
John E. Lawrence
; Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, UK
Daniel M. Fountain
; Hughes Hall College, Cambridge, School of Clinical Medicine, University of Cambridge, Cambridge, UK
Mark Agius
; Clare College Cambridge, The University of Cambridge, Cambridge, UK ; South Essex Partnership University Foundation Trust, UK ; Department of Psychiatry, University of Cambridge, Cambridge, UK
Abstract
Background: Encephalitis associated with antibodies targeted against the N-methyl-D-aspartate (NMDA) receptor is
increasingly recognised as a major cause of an acute presentation of organic psychosis. Misdiagnosis and subsequent inappropriate
referral to psychiatric services is common and avoidable. This review focuses on addressing this issue in the acute setting.
Methods: The authors present a review of existing literature relating to the pathophysiology and presentation of anti-NMDA
receptor encephalitis, prior to proposing a management pathway avoiding delays to treatment incurred through misdiagnosis or
inappropriate referral.
Conclusions: Acute care physicians should have a low threshold for suspecting anti-NMDA receptor encephalitis in any patient
presenting with acute psychosis in the context of non-specific coryzal and constitutional symptoms in whom infective causes have
been excluded. The presence of pleocytosis and reduced protein in routine CSF analysis should further raise suspicion, and samples
should be sent for immunohistochemical testing. Availability and efficiency of this testing is currently suboptimal.
Keywords
anti-NMDA receptor encephalitis; organic acute psychosis
Hrčak ID:
265730
URI
Publication date:
5.11.2014.
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