SHM Converge Scientific Abstract ePoster Gallery-Muted by the Mind: A Case of Anti-Nmda Receptor Encephalitis

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This case describes a 13-year-old previously healthy girl with psychosocial stressors and a recent seizure-like event who developed 2 months of progressive expressive aphasia and 2 weeks of right upper extremity sensorimotor changes. On exam, she was well-appearing but nearly nonverbal, with subtle hyperkinetic right-hand movements and emotional distress related to her aphasia.<br /><br />Initial workup was largely unrevealing: CBC, CMP, inflammatory markers, thyroid studies, urine drug screen, complement levels, and MRI brain were normal. EEG, however, showed focal epileptiform activity and slowing over the left hemisphere. CSF later revealed lymphocytic pleocytosis, elevated IgG index, positive oligoclonal bands, and a pediatric autoimmune encephalitis panel positive for anti-NMDA receptor IgG. Pelvic ultrasound and MRI were negative for ovarian teratoma.<br /><br />The case highlights the importance of considering autoimmune encephalitis in children with subacute onset of speech dysfunction, seizures, abnormal movements, and behavioral changes, even when early tests are normal. Anti-NMDA receptor encephalitis can present with variable neurologic and psychiatric symptoms, and up to one-third of patients may have initially normal MRI, EEG, or CSF results.<br /><br />She met Graus diagnostic criteria for probable autoimmune encephalitis based on subacute symptoms, focal neurologic findings, and exclusion of other causes. Treatment included lacosamide, high-dose IV methylprednisolone, IVIG, and a prolonged steroid taper with monthly IVIG. Her speech gradually improved, and with ongoing neurology and rheumatology follow-up, she ultimately returned to baseline. Early recognition and empiric treatment were emphasized as key to preventing progression.

Asset Subtitle

Initha Setiady

Meta Tag

Author List Arshiya Ahuja, Faris Almubaslat, Initha Setiady, James Newton, Jessica L. Guidici, Meghan L. McCarthy

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Graus Diagnostic Criteria

Concept Autoimmune Encephalitis

Concept Subacute Onset

Concept Neurologic Symptoms

Distinguished Non-Finalist

Presenter Organization University of North Carolina Hospitals

Presenting Author Initha Setiady

Track Pediatric

Keywords

autoimmune encephalitis

anti-NMDA receptor encephalitis

expressive aphasia

pediatric neurology

seizure-like event

CSF lymphocytic pleocytosis

oligoclonal bands

focal epileptiform activity

IV methylprednisolone

intravenous immunoglobulin

Anti-NMDA Receptor Encephalitis

Graus Diagnostic Criteria

Autoimmune Encephalitis

Subacute Onset

Neurologic Symptoms