Anti-NMDAR encephalitis with seizure-like activity and hemiplegia - a case report and literature review

Abstract

Background

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis accounts for the vast majority of cases of autoimmune encephalitis. Its common clinical symptoms are psychiatric symptoms, behavioral dysfunction, seizures, speech impairment, cognitive impairment, movement disorders, decreased consciousness, and autonomic instability. This report was aimed to provide evidence for anti-NMDAR encephalitis with seizure-like activity, based on the clinical presentations, brain magnetic resonance imaging (MRI), and electroencephalogram (EEG) recordings.

Case presentation

We report a 11-year-old girl who suffered epigastric pain after vigorous physical activity. She felt weakness of the muscles. She had syncope only once and urinary incontinence on the way to the hospital and vomited at the arrival. The entire procedure lasted approximately 15 min. The next night she had recurrent headache attacks along with irritability, like someone “tapping” to the right occipital region. She experienced numbness in the left upper limbs and shallowing of the frontal lines on the left side. Holter monitoring showed normal findings, but brain MRI, EEG recording, and cerebrospinal fluid (CSF) antibody testing showed abnormal results. The patient was finally diagnosed with anti-NMDAR encephalitis. After treatment with glucocorticoids and acyclovir, she fully recovered and was discharged from the hospital.

Conclusions

Although the patient presented with pain and impaired limb movements, she did not have respiratory or (and) circulatory failure, and the symptoms entirely resolved. Early accurate diagnosis and timely treatment are essential for patients with anti-NMDAR encephalitis.