SHM Converge Scientific Abstract ePoster Gallery-Seizing Aphasia: A Curious Case of Anti-Nmdar-Encephalitis

Pdf Summary

This case report describes an 18-year-old woman with anti-NMDA receptor encephalitis presenting in an unusual way: repetitive focal seizure-like spells and profound speech apraxia. She initially developed seizures with loss of consciousness, then episodes of involuntary mouth opening and forced vocalization, followed by a rapid loss of speech. Her family also noticed decreased appetite, weight loss, and agitation. Because video EEG at another hospital showed no epileptiform activity, she was initially diagnosed with psychogenic nonepileptic attacks.<br /><br />At presentation, she was unable to speak but could still understand language and communicate by writing. Clinicians suspected anti-NMDAR encephalitis and began treatment immediately with high-dose methylprednisolone and levetiracetam. MRI showed cortical diffusion restriction in bilateral frontal premotor regions and the insula, findings felt to be seizure-related. Video EEG captured her clinical spells without epileptiform discharges, though temporal slowing was noted. Lacosamide was added, stopping the seizures. CSF showed mild pleocytosis and oligoclonal bands. Despite seizure control, she continued to have severe speech apraxia, agitation, subtle orofacial dyskinesia, and fever, so IVIG was started with marked improvement. Her serum and CSF later returned positive for NMDA receptor antibodies, confirming the diagnosis. By follow-up, she had full recovery of speech and remained seizure-free.<br /><br />The report emphasizes that anti-NMDAR encephalitis has a wide range of neuropsychiatric presentations and can be misdiagnosed, especially when symptoms resemble psychiatric illness or nonepileptic events. It should be considered in young patients with new-onset seizures, speech disturbance, agitation, and rapid neurologic decline. Because antibody testing may take weeks, treatment should begin based on clinical suspicion and imaging rather than waiting for confirmatory results. Early recognition and prompt immunotherapy can lead to excellent outcomes.

Asset Subtitle

Nobel D. Nguyen

Meta Tag

Author List Jaspreet Garcha, Johnson Ong, Mostafa Hammoudi, Nobel D. Nguyen

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Neuropsychiatric Symptom

Concept Immunotherapy

Concept Neurologic Symptoms

Concept Focal Seizure

Distinguished Non-Finalist

Presenter Organization Community Memorial Health System

Presenting Author Nobel D. Nguyen

Track Adult

Keywords

anti-NMDA receptor encephalitis

speech apraxia

focal seizures

psychogenic nonepileptic attacks

video EEG

orofacial dyskinesia

methylprednisolone

intravenous immunoglobulin

NMDA receptor antibodies

young woman

Anti-NMDA Receptor Encephalitis

Neuropsychiatric Symptom

Immunotherapy

Neurologic Symptoms

Focal Seizure