Objective: This case study examines a 15 year-old, right-handed Hispanic female diagnosed with Anti-N-methyl-d-aspartate receptor encephalitis (Anti-NMDAR-E), a rare life threatening condition. NMDA receptors are found in the forebrain, hypothalamus, and limbic system structures including hippocampus. Along with psychiatric symptoms, cognitive symptoms may include fast deterioration of short and long-term memory, attention, and executive functioning. Literature pertaining to neuropsychological sequelae of Anti-NMDAR-E is scarce. This case provides a more comprehensive understanding of how Anti-NMDAR-E impacts psychosocial and neurocognitive processes. Method: Two weeks prior to symptom onset, XX received a Menactra vaccine. Initial symptoms included confusion, hyperverbosity and incoherence alternating with stupor and mutism. Physically, she presented with lip smacking and hyper-perspiration. Behavior was characterized by restlessness, agitation, and aggression. Subsequently, she became catatonic with irregular vitals. Feelings of derealization, auditory hallucinations and paranoid ideation were present. Results: Testing occurred 15 months post-illness onset. Neuropsychological test scores ranged from Impaired to Superior. Areas of weakness included cognitive flexibility, sustained auditory attention, design fluency, left sensory-perceptual misperceptions, and difficulty working under time pressure. XX demonstrated intact knowledge of word meaning, adequate verbal abstract reasoning, and well-preserved fund of knowledge. Visual attention, visuoconstructional, and memory/learning abilities were within normal limits. Areas of strength included problem solving strategies, processing speed, visual attention, and overall academic achievement. XX had a perfectionistic disposition and her emotional profile was remarkable for anxiety. Conclusion: This case study presents a 15 year-old female with predominantly attentional and executive function deficits following Anti-NMDAR-E. Variability in neuropsychological profile among cases is confirmed, likely multi-factorial in nature.
Neuropsychological Sequelae of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in a 15 Year-Old Hispanic Female
G Leal, A Chan, S Ireland; C-10
Neuropsychological Sequelae of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in a 15 Year-Old Hispanic Female. Arch Clin Neuropsychol 2016; 31 (6): 644. doi: 10.1093/arclin/acw043.159
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