To report a case and propose a potential pathway for evaluation and management of anti-NMDAR encephalitis in pregnancy. 

Anti-NMDA encephalitis during pregnancy is challenging for neurologists and requires multi-interdisciplinary care. Anti-NMDA receptor encephalitis is associated with behavioral disturbances including psychosis and seizures. Obstacles arise when evaluating and treating these patients including choosing imaging modalities, use of contrast, and interventions. Though there are published reports of anti-NMDAR encephalitis in pregnancy, we propose a potential pathway for evaluation and management in this patient population. 

Case report and literature review. 

A 19-year-old female with a history of unspecified seizure disorder and 15 weeks pregnant presented with subacute behavioral changes including psychosis and catatonia. Urine toxicology was negative. MRI brain was unremarkable. CSF findings were only significant for oligoclonal bands. Thirteen days after hospitalization, NMDAR antibody was positive in the CSF while negative in the serum. Abdominal ultrasound and MRI abdomen/pelvis were negative for an ovarian teratoma. She was started on plasma exchange prior to knowledge of positive CSF NMDAR antibody due to high clinical suspicion. Once the diagnosis was made, the patient was started on high dose intravenous methyl-prednisolone with improvement in symptoms.