Anti-N-methyl-D-aspartate receptor encephalitis relapse in the brainstem

Description

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder involving IgG antibody reaction against NMDAR. It typically develops in women with ovarian teratoma, and its characteristic clinical symptoms include acute behavioural change, psychosis, movement disorder, seizure and autonomic dysfunction. Long-term management in an intensive care unit and immunosuppressive therapy are necessary in most cases, but good prognosis is achieved with appropriate treatment.1 Here, we report a case of anti-NMDAR encephalitis that improved without treatment, but relapsed involving a different brainstem lesion without any symptoms.

A 36-year-old woman was admitted with headache and a single partial seizure 2 weeks after influenza-like fever. At admission, her physical and neurological examination findings as well as routine blood examination results were normal. Cerebrospinal fluid (CSF) analysis revealed a cell count of 163/μL (neutrophil-to-lymphocyte ratio, 15:1) and protein level of 47 mg/dL. MRI showed slight swelling in the limbic system. Meningitis was suspected;...

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