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Case report
Autoimmune encephalitis: the clinical evolution as a key to the diagnosis
  1. Sara Teixeira1,
  2. Joana Caldeira Santos1,
  3. Marta Vila Real2 and
  4. Fátima Santos2
  1. 1 Pediatrics Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  2. 2 Unit of Neurosciences of Childhood and Adolescence, Pediatric Service, Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal
  1. Correspondence to Dr Sara Teixeira, sara_tp{at}


Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a devastating disease, that despite being increasingly diagnosed, there are no consensus guidelines for the optimal management. A previously healthy 3-year-old-boy brought to the emergency department due to seizures. Neurological examination was normal, and electroencephalogram (EEG) suggested focal epilepsy. Anticonvulsive medication was initiated. He progressively lost age-appropriate language skills, presented behavioural changes and psychiatric symptoms. Neurological examination at that time revealed symmetric gross motor weakness of the lower limbs. Brain and spinal cord MRI and cerebrospinal fluid were normal. Repeated EEG showed global lentification. Steroid therapy was initiated for the suspicion of autoimmune encephalitis, later confirmed as NMDAR encephalitis. He became clinically improved after 10 days of treatment but only returned to his baseline after 3 months of disease onset. The authors emphasised the variable course of the disease and possible late response to treatment.

  • paediatrics
  • child and adolescent psychiatry (paediatrics)
  • epilepsy and seizures
  • neurology

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  • Contributors All named authors have contributed for this work and the manuscript has been read and approved by them. ST wrote the article and did the research necessary for its production. JCS helped in the elaboration of the case description. MVR and FS contributed to the patient orientation and in the article review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.