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Delirium – Anticholinergic Drug Burden — SCE Neurology MCQ

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HardNeuropsychiatryDelirium – Anticholinergic Drug BurdenSCE Neurology

A 21-year-old develops psychosis, seizures, orofacial dyskinesia and autonomic instability. CSF shows lymphocytes and oligoclonal bands; EEG has diffuse slowing and infection studies are negative. Anti-NMDAR encephalitis is suspected. What investigation should accompany first-line immunotherapy?

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Correct answer: B — Pelvic imaging and age-based tumour screening

The best answer is “Pelvic imaging and age-based tumour screening”. Anti-NMDAR encephalitis is associated with ovarian teratoma, particularly in young women; early tumour search and removal, when present, are integral to immunotherapy and outcome. “Dopamine-transporter SPECT as the definitive antibody test” is less appropriate because dopamine-transporter imaging neither detects NMDAR antibodies nor screens for the associated tumour “Carotid angiography to exclude an embolic movement disorder” is less appropriate because the syndrome is diffuse autoimmune encephalitis rather than a focal embolic disorder “Muscle biopsy to identify the source of dyskinesia” is less appropriate because orofacial dyskinesia arises from brain dysfunction and is not a primary myopathy “Delay tumour investigation until after six months of psychiatric treatment” is less appropriate because delayed tumour identification can perpetuate the immune trigger and worsen recovery

Reference: A clinical approach to diagnosis of autoimmune encephalitis. https://pmc.ncbi.nlm.nih.gov/articles/PMC5066574/