Abstract Details

Title Anti-NMDA Receptor Encephalitis Presenting with Autonomic Dysfunction.

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 064

Objective

Anti-NMDA receptor encephalitis is the most common autoimmune encephalitis which generally presents with psychiatric symptoms - most commonly visual and auditory hallucinations, depression, mania, acute schizoaffective disorder, or neurological symptoms including memory loss and/or seizures. The disease also has a higher predilection for women and younger patients, with a median age of 20. There is notably a viral-like prodrome after which there may be intermittent behavioral changes, difficulty concentrating, problems with recall or aggression. Dysautonomia including hyperthermia, hypertension, hypotension, cardiac dysfunction, urinary incontinence and/or erectile dysfunction may be present. Dysautonomia as an initial symptom is an unusual presentation of this disease.

Background We discuss a 49-year-old man with ESRD on hemodialysis, type 1 diabetes mellitus who presented with autonomic dysfunction with recurrent episodes of hypertensive emergency/urgency and hypotension sometimes with associated altered mental status. At the initial encounter, the patient was diagnosed with hypertensive encephalopathy due to altered mental status in the context of significantly elevated blood pressure found to be 233/143. The degree of autonomic instability was significant enough to cause labile severe hypertension alternating with hypotension requiring pharmacological intervention. Subsequently, the patient developed seizures, with altered mentation and aggressive behavior. Multiple routine EEG studies and MRIs of the brain were completed and were without significant abnormalities. Nine months after the initial encounter, CSF studies were performed due to persistent encephalopathy, and were found to be positive for Anti-NMDAR antibodies. Our case discusses dysautonomia as the presenting symptom of NMDAR encephalitis, and due to the underrepresented nature of presentation, the patient was diagnosed after several months.

Design/Methods N/A

Results N/A

Conclusions

Common presentations of NMDA encephalitis include psychiatric illnesses or neurological symptoms. Presenting symptoms of dysautonomia as a manifestation of NMDA receptor encephalitis are uncommon, and as seen with our patient, can lead to a delay of diagnosis and treatment.

Authors/Disclosures
Jayasai Jeyarajan, MD PRESENTER	Dr. Jeyarajan has nothing to disclose.
Sohaib M. Lateef, MD	Dr. Lateef has nothing to disclose.
Mariam Noor, MD (University of Toledo)	Dr. Noor has nothing to disclose.
Imran I. Ali, MD, FAAN (University of Toledo COM)	Dr. Ali has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for ABPN.

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