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Post Herpes Simplex Virus (HSV) NMDA Encephalitis

Authors: Din, Nizamud; Nadeem, Muhammad Daniyal; Ullah, Saleem;

Post Herpes Simplex Virus (HSV) NMDA Encephalitis

Abstract

{"references": ["1.\tDalmau J, T\u00fcz\u00fcn E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25\u201336. https://doi.org/10.1002/ana.21050", "2.\tTsutsui K, Kanbayashi T, Tanaka K, et al. Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features. BMC Psychiatry. 2012;12:37. Published 2012 May 8. https://doi.org/10.1186/1471-244X-12-37", "3.\tMann A, Machado NM, Liu N, et al. A multidisciplinary approach to the treatment of anti-NMDA-receptor antibody encephalitis: a case and review of the literature. J Neuropsychiatry Clin Neurosci. 2012;24(2):247\u2013254. https://doi.org/10.1176/appi.neuropsych.11070151", "4.\tKuppuswamy P, Takala C, Sola, C. Management of psychiatric symptoms in NMDAR encephalitis: a case series, literature review and future directions. Gen Hosp Psychiatry. 2014;36(4):388\u2013391. https://doi.org/10.1016/j.genhosppsych.2014.02.010", "5.\tM. Espinola-Nadurille, P. Bautista-Gomez, J. Flores et al., \"Non-inflammatory cerebrospinal fluid delays the diagnosis and start of immunotherapy in anti-NMDAR encephalitis,\" Arquivos de Neuro-Psiquiatria, vol. 76, no. 1, pp. 2\u20135, 2018", "6.\tDalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008;7:1091-98."]}

Anti-N-methyl D-aspartate (NMDA) receptor (anti-NMDAR) encephalitis is caused by immunoreactivity against the NR1 subunit of the NMDA receptor. The anti NMDAR encephalitis has strong association in patients with Herpes Simplex Virus (HSV) encephalitis. Post viral infection the cause of encephalitis was of the autoimmune type (Anti NMDAR Encephalitis). We present that case of a twenty-one-year-old female with acute confusion, irrelevant talk, abnormal behavior and one episode of generalized tonic clonic seizure. She was hospitalized 25 days back with febrile encephalopathy with a positive CSF-PCR for HSV Type 2. Patient was started on steroids and autoimmune encephalitis antibodies profile was sent. This came positive for NMDA receptor and negative for CASPR-2, Type AMPA1/2, LGI-1, DPPX, and GABAB receptor antibodies. The patient was administered IV rituximab every four weeks after a poor outcome with steroid therapy. The patient was doing well on four weeks follow up. Herpes Simplex Virus (HSV) infection preceded the diagnosis of NMDA Encephalitis. The diagnosis of autoimmune encephalitis should be considered a top differential in relapsing patients as it has a very wide range of presentation. Prompt diagnosis and early treatment are the need of the hour as the ramifications of a mis or missed diagnosis could be detrimental

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Keywords

Encephalitis;, NMDA, NORSE

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This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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