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Case report
CSF studies which ultimately led to the possible diagnosis of anti-NMDAR encephalitis
  1. Caroline Roberts,
  2. Morgan McEachern and
  3. Anne Mounsey
  1. Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Caroline Roberts; caroline_roberts{at}


A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recently discharged from his first psychiatric hospitalisation. Many studies were performed, including electroencephalogram (EEG), head CT, laboratory work, urine drug screen and lumbar puncture with cerebral spinal fluid studies, which ultimately led to the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis. He was treated with five rounds of plasmapheresis with complete resolution of his altered mental status. This case highlights the importance of being familiar with the presentation of anti-NMDAR autoimmune encephalitis, especially in cases of new-onset mental status changes with psychotic like symptoms, seizure-like activity and autonomic dysregulation as early detection and treatment improves chances of good prognosis with return to baseline cognitive function.

  • prehospital
  • neurology
  • paediatrics
  • child and adolescent psychiatry
  • delirium

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  • Contributors CR and MME co-authored this manuscript in all of the planning, conduct and reporting of the work described in the article and contributed equally to this paper. AM was instrumental in guidance and editing of the manuscript.

  • 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.

  • Patient consent for publication Parental/guardian consent obtained.

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