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Anti-NMDA Receptor Encephalitis — RACP Adult Medicine MCQ

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ModerateNeurologyAnti-NMDA Receptor EncephalitisRACP Adult Medicine

A 22-year-old woman presents with acute psychiatric symptoms (psychosis, agitation), seizures, dyskinesias (orofacial movements), autonomic instability, and decreased consciousness over 2 weeks. MRI brain is normal. CSF shows mild lymphocytic pleocytosis. Anti-NMDA receptor antibodies are positive in CSF. Pelvic ultrasound shows a 5 cm ovarian teratoma. What is the most likely diagnosis?

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Correct answer: A — Anti-NMDA receptor encephalitis

Acute psychiatric symptoms, seizures, movement disorder (orofacial dyskinesias), autonomic instability, and decreased consciousness in a young woman with positive anti-NMDA receptor antibodies and ovarian teratoma is anti-NMDA receptor encephalitis. Treatment: tumour removal (teratoma), first-line immunotherapy (IVIG or PLEX + corticosteroids), and second-line (rituximab ± cyclophosphamide) if refractory.

Reference: Graus 2016 Autoimmune Encephalitis Criteria; eTG Neurology 2024