[First occurrence of an organic manic schizophreniform syndrome followed by catatonia induced by anti-NMDA-receptor encephalitis]

Fortschr Neurol Psychiatr. 2013 Apr;81(4):206-9. doi: 10.1055/s-0033-1335044. Epub 2013 Mar 15.
[Article in German]

Abstract

We report on a 39-year-old female patient who developed catatonia after there had been schizomanic symptoms in the six months before. At admission the patient exhibited catatonia, a tetraspastic syndrome and focal epileptic seizures. The cranial MRI revealed bilateral subcortical hyperintense lesions which took up contrast agent. Examination of the cerebrospinal fluid disclosed a lymphocytic pleocytosis and autochthone oligoclonal bands. In the serum autoantibodies against the NMDA-NR-1 receptor were reproducibly detected. A detailed search for a tumour was negative. In detail, we could exclude a neoplasm of the ovaries which is often present in the paraneoplastic type of anti-NMDA-receptor encephalitis. Therefore we assume an autoimmune, not paraneoplastic, encephalitis in our patient. The symptoms improved significantly after an immunosuppressive therapy - initially with glucocorticoids followed by rituximab - had been initiated. This case illustrates that an autoimmune encephalitis should be looked for when first psychotic symptoms occur.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / psychology*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Autoantibodies / analysis
  • Autoantibodies / immunology
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / psychology
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / etiology*
  • Bipolar Disorder / psychology*
  • Catatonia / etiology
  • Catatonia / psychology
  • Electroencephalography
  • Epilepsies, Partial / etiology
  • Epilepsies, Partial / psychology
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Magnetic Resonance Imaging
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / etiology*
  • Psychotic Disorders / psychology*
  • Receptors, N-Methyl-D-Aspartate / immunology
  • Rituximab

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Autoantibodies
  • Immunosuppressive Agents
  • Receptors, N-Methyl-D-Aspartate
  • Rituximab