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Anti-NMDAR encephalitis — RACP Paediatrics MCQ

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HardNeurologyAnti-NMDAR encephalitisRACP Paediatrics

A 14-year-old girl presents with new-onset psychiatric symptoms (paranoia, hallucinations), seizures, and movement disorder (orofacial dyskinesias) over 2 weeks. MRI brain is normal. CSF shows mild lymphocytic pleocytosis. She has a history of an ovarian teratoma. What is the most likely diagnosis?

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Correct answer: C — Autoimmune encephalitis (anti-NMDAR)

Psychiatric symptoms, seizures, and movement disorder (particularly orofacial dyskinesias) in a young female with an ovarian teratoma is classic anti-NMDA receptor encephalitis. Anti-NMDAR antibodies in CSF confirm diagnosis. Treatment includes immunotherapy (IVIg, methylprednisolone, plasma exchange) and tumour removal if present.

Reference: RCH Melbourne – 2023 – Encephalitis CPG; RACP Paediatric Curriculum – Neurology