Abstract
Background: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is difficult to diagnose due to the variability of early symptoms. With an estimated incidence of only 1.5 per 1 million population per year (mean age: 23 years), this type of encephalitis is a very rare disorder. Given the limited number of patients, it is important to improve our understanding of pathophysiological mechanisms and therapeutic strategies to improve prognosis.
Case presentation: We report the case of a 21-year-old man who presented to the emergency room after experiencing acute behavioral disturbances, auditory hallucinations, and panic attacks. Due to decreased consciousness and inability to maintain airway patency, the patient was intubated, and then a percutaneous dilatation tracheostomy was performed. The cerebrospinal fluid test results were positive for antibodies to NMDA receptors. After intravenous methylprednisolone and plasmapheresis, the patient’s clinical condition gradually improved, and decannulation was performed 37 days after insertion. The patient was subsequently treated as an outpatient with complication sequelae in the form of dementia due to anti-NMDAR encephalitis.
Conclusions: Anti-NMDAR encephalitis is difficult to diagnose because psychiatric symptoms predominate. There is no specific therapy for anti-NMDAR encephalitis, so further research is needed to find the most effective immunotherapy regimen. Because the diagnosis and recovery process of anti-NMDAR encephalitis takes a long time, supportive therapy in intensive care plays an important role in overall management to produce a good prognosis.
Irham Hanafi, Akhmad Yun Jufan, Bowo Adiyanto
