Dados do Trabalho

Título

Relapsing anti-NMDA receptor encephalitis: case report

RESUMO

A previously healthy 16-year-old female patient presented with an episode of tonic seizures. After 05 days, she evolved with syncope. One month later, she had seizures characterized by ocular supraversion, followed by loss of consciousness, limb hypertonia, and drooling. She progressed with behavioral changes, visual hallucinations, gait and language alterations. In addition, she had psychomotor agitation, urinary and fecal incontinence, and oromandibular dyskinesias. Cerebrospinal fluid analysis showed pleocytosis. Brain MRI was normal. Tomographic screening of neoplasms was negative. The electroencephalogram was suggestive of nonspecific encephalopathy. In view of the subacute onset of psychiatric symptoms, associated with new focal neurological findings, the presence of epileptic seizures and CSF pleocytosis, the patient fulfilled diagnostic criteria for autoimmune encephalitis. She performed an immunological panel on CSF, which confirmed the diagnosis of anti-NMDA receptor encephalitis. During hospitalization, she underwent pulse therapy with immunoglobulin and methylprednisolone, showing a significant improvement in her condition. After 4 years, she evolved with disease recurrence, characterized by agitation, aggression, disorientation, behavioral alteration, visual hallucinations, and generalized tonic-clonic seizures. She underwent pulse therapy with methylprednisolone and immunoglobulin again, showing complete remission. DISCUSSION: Anti-NMDA autoimmune encephalitis is an inflammatory condition of the brain triggered by the production of antibodies against the NMDA receptor on the neuronal cell surface. It predominantly affects young women. The initial symptom is usually neuropsychiatric, followed by cognitive dysfunction, movement disorders, decreased level of consciousness, autonomic dysfunction, and hypoventilation. Epileptic seizures tend to occur at any time during the illness. MRI is altered in about a third of patients. The CSF is altered in about 80% of cases. EEG reveals abnormal findings in around 90% of patients. Although it is a disease better known as monophasic, some patients can evolve with recurrence of symptoms. FINAL CONSIDERATIONS: The present report aims to describe a case of relapsing anti-NMDA encephalitis, characterizing an atypical evolution of the disease.

Palavras Chave

encephalitis; autoimmune; anti-NMDA; relapsing