Advertisement

European Journal of Pediatrics

, Volume 173, Issue 5, pp 681–683 | Cite as

Anti-N-methyl-d-aspartate receptor encephalitis in a pre-teenage girl: a case report

  • Stephanie Nijmeijer
  • Sander Bontemps
  • Leonie Naeije
  • Jonathan CoutinhoEmail author
Case Report

Abstract

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an auto-immune and paraneoplastic encephalitis which generally affects young adults. It is a multistage illness, with prominent extrapyramidal, neuropsychiatric and autonomic symptoms. The syndrome is frequently associated with an ovarian teratoma. Recently, it has become evident that anti-NMDAR encephalitis is more common in children and adolescents than was previously believed. Prognostic factors that determine a good outcome are presence of a tumour, prompt treatment and no need for admission to an intensive care unit. Increased awareness among paediatricians of this potentially life-threatening disease is important because early recognition and treatment will improve the patients’ chances of a good clinical outcome. In this case report, we describe a 9-year-old girl with behavioural changes and severe extrapyramidal symptoms due to anti-NMDAR encephalitis associated with an ovarian teratoma. She was treated with a variety of immunomodulating therapies and made a slow, but good recovery.

Keywords

Anti-N-methyl-d-aspartate receptor Encephalitis Teratoma Children 

Abbreviations

Anti-NMDAR

Anti-N-methyl-d-aspartate receptor

CSF

Cerebrospinal fluid

NMDAR

N-methyl-d-aspartate receptor

PICU

Paediatric intensive care unit

Notes

Consent

The parents of the patient gave informed consent for publication of this case report.

Conflict of Interest

The authors declare that they have no competing interests.

References

  1. 1.
    Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR (2007) Paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 61(1):25–36PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7(12):1091–1098PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10(1):63–74PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, Campen CJ, Moss H, Peter N, Gleichman AJ, Glaser CA, Lynch DR, Rosenfeld MR, Dalmau J (2009) Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 66(1):11–18PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA (2012) The frequency of autoimmune N-methyl-d-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 54(7):899–904PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Mirza MK, Pogoriler J, Paral K, Ananthanarayanan V, Mandal S, Mazin A, Baron B, Richa E (2011) Adjunct therapeutic plasma exchange for anti-N-methyl-d-aspartate receptor antibody encephalitis: a case report and review of literature. J Clin Apher 26(6):362–365PubMedCrossRefGoogle Scholar
  7. 7.
    Naoura I, Didelot A, Walker F, Luton D, Koskas M (2011) Anti-N-methyl-d-aspartate receptor encephalitis complicating ovarian teratomas: a case report. Am J Obstet Gynecol 205(4):6–8CrossRefGoogle Scholar
  8. 8.
    Titulaer MT, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 12:157–165PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Stephanie Nijmeijer
    • 1
  • Sander Bontemps
    • 2
  • Leonie Naeije
    • 3
  • Jonathan Coutinho
    • 4
    Email author
  1. 1.Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Pediatric Intensive Care, Academic Medical Centre, Emma Children’s HospitalUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Pediatrics, Academic Medical Centre, Emma Children’s HospitalUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Neurology, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations