Objective: The case describes cognitive and behavioral functioning in a 16-year-old female with a history of Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis. Anti-NMDAR encephalitis is a little-known form of autoimmune encephalitis primarily affecting female patients and associated with neoplasms, particularly ovarian teratomas. While the acute stages of the disease are associated with severe cognitive impairment and behavioral changes, long-term neuropsychological outcomes are not well understood as only several case studies exist. The present case study adds to the growing body of literature describing the neuropsychological profile of a patient with a history of anti-MNDAR encephalitis. Method: 16-year-old A developed a headache and fever, followed by difficulty walking, confusion and auditory hallucinations. She spent the next 3-4 months in the ICU where she was diagnosed with anti-NMDAR encephalitis. A left ovarian teratoma was identified and A underwent surgery and chemotherapy. Although epileptiform activity was not recorded on EEGs, partial seizures were suspected and treated. Approximately three months into the illness, A began to show improvement and was transferred to a subacute rehabilitation facility, which was followed by a day treatment program and then outpatient rehabilitation services. While A's functioning improved, she continued to display impulsive behavior and poor judgment raising concerns about her safety. A had extensive amnesia and was reported to show significant learning problems interfering with her school performance. More recently, A began to exhibit signs of psychological distress and express suicidal ideation. She began seeing a psychiatrist and a therapist who referred her for neuropsychological assessment. Results: A exhibited significant impairment in auditory and visual memory, select executive functions, expressive language and fine motor control. Mild difficulties were noted in perceptual reasoning, attention and visual spatial functions. She was also experiencing emotional difficulties, including stress in social relationships, low self-esteem and symptoms of depression. Conclusion: Results add to the small body of literature that indicates that neuropsychological effects of anti-NMDAR encephalitis can be severe and persistent. Previous longitudinal case studies suggest that these deficits could be reversible with appropriate neurorehabilitation. Follow-up assessment was recommended to determine the course of A's cognitive and emotional functioning.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER
Cognitive Sequelae of Anti-N-Methyl-D-Aspartate Receptor Encephalitis
E Ostroy; NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER
Cognitive Sequelae of Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Arch Clin Neuropsychol 2015; 30 (6): 489. doi: 10.1093/arclin/acv047.08
Download citation file:
© 2017 Oxford University Press×