Anti-NMDA receptor encephalitis - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2020-11-14T13:46:41Z

Differential Diagnosis

← Older revision		Revision as of 13:46, 14 November 2020
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	*[[Drugs]], [[toxins]], [[Alcohol withdrawal\|withdrawal]]<ref>Punja M, Pomerleau JJ, Devlin MW, et al. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential diagnosis of delirium. Clin Toxicol 2013 Sep-Oct;51:794-7. PMID: 23962100</ref>		*[[Drugs]], [[toxins]], [[Alcohol withdrawal\|withdrawal]]<ref>Punja M, Pomerleau JJ, Devlin MW, et al. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential diagnosis of delirium. Clin Toxicol 2013 Sep-Oct;51:794-7. PMID: 23962100</ref>

			{{Movement disorder DDX}}
	{{AMS DDX}}		{{AMS DDX}}

ClaireLewis at 22:17, 1 October 2019

2019-10-01T22:17:45Z

← Older revision		Revision as of 22:17, 1 October 2019
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	*Female predominance (up to 80-90%)		*Female predominance (up to 80-90%)
	*Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>		*Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>
	*Viral like prodrome (headache, low-grade fever, malaise)		*[[viral syndrome\|Viral like prodrome]] ([[headache]], low-grade [[fever]], malaise)
	*Psychiatric manifestations (anxiety, agitation, bizarre behavior, hallucinations, etc)and or decreased level of consciousness <ref name="clinical"></ref>		*Psychiatric manifestations ([[anxiety]], [[agitation]], bizarre behavior, [[hallucinations]], etc) and/or [[AMS\|decreased level of consciousness]] <ref name="clinical"></ref>
	*Dyskinesia, movement disorders and increased rigidity		*Dyskinesia, movement disorders and increased rigidity
	*Autonomic instability: hyperthermia, ~~tachy~~/~~brady~~,BP fluctuations, hypoventilation		*Autonomic instability: [[hyperthermia]], [[tachycardia]]/[[bradycardia]], BP fluctuations, hypoventilation
	*Lethargy, seizures		*[[Lethargy]], [[seizures]]
	===Physical===		===Physical===
	*Abnormality in vitals as above, rarely may find abdominal mass		*Abnormality in vitals as above, rarely may find abdominal mass

	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Viral encephalitis]]		*[[Viral encephalitis]]
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	*[[Addison's disease]]<ref name="Wadinger">Wandinger K, Saschenbrecker S, Stoecker W, Dalmau J Anti-NMDA-receptor encephalitis: A severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol. 2011 Feb;231(1-2):86-91. PMID: 20951441</ref>		*[[Addison's disease]]<ref name="Wadinger">Wandinger K, Saschenbrecker S, Stoecker W, Dalmau J Anti-NMDA-receptor encephalitis: A severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol. 2011 Feb;231(1-2):86-91. PMID: 20951441</ref>
	*[[Catatonia]]<ref name="Wadinger"></ref>		*[[Catatonia]]<ref name="Wadinger"></ref>
	*Cerebral space occupying lesions		*[[intracranial mass\|Cerebral space occupying lesions]]
	*[[Drugs]], [[toxins]], [[Alcohol withdrawal\|withdrawal]]<ref>Punja M, Pomerleau JJ, Devlin MW, et al. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential diagnosis of delirium. Clin Toxicol 2013 Sep-Oct;51:794-7. PMID: 23962100</ref>		*[[Drugs]], [[toxins]], [[Alcohol withdrawal\|withdrawal]]<ref>Punja M, Pomerleau JJ, Devlin MW, et al. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential diagnosis of delirium. Clin Toxicol 2013 Sep-Oct;51:794-7. PMID: 23962100</ref>

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	==Disposition==		==Disposition==
	*Admission with ~~Neurology Consult~~		*Admission with neurology consult

	==See Also==		==See Also==
	*[[Altered mental status]]		*[[Altered mental status]]
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	<references/>		<references/>

	~~[[Category:Toxicology]]~~
	[[Category:Neurology]]		[[Category:Neurology]]

ClaireLewis: /* Management */

2016-11-13T23:06:48Z

Management

← Older revision		Revision as of 23:06, 13 November 2016
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	*Resection of tumor if there is an associated mass<ref name="treatment">Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013 Feb;12(2):157-65. PMID: 23290630		*Resection of tumor if there is an associated mass<ref name="treatment">Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013 Feb;12(2):157-65. PMID: 23290630
	</ref>		</ref>
	*~~Glucocorticoids~~<ref name="treatment"></ref>		*[[Corticosteroids]]<ref name="treatment"></ref>
	*IVIG<ref name="treatment"></ref>		*[[IVIG]]<ref name="treatment"></ref>
	*Plasma exchange		*[[Plasma exchange]]
	*Second line rituximab and cyclophosphamide<ref name="treatment"></ref>		*Second line: [[rituximab]] and [[cyclophosphamide]]<ref name="treatment"></ref>

	==Disposition==		==Disposition==
	*Admission with Neurology Consult		*Admission with Neurology Consult

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T20:01:45Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 20:01, 13 November 2016
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	*EEG: to rule out seizure with movement disorders		*EEG: to rule out seizure with movement disorders
	*MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions		*MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions
	*Pelvic US or CT or MRI to evaluate for associated ovarian teratoma		*Pelvic [[ultrasound]] or CT or MRI to evaluate for associated ovarian teratoma

	==Management==		==Management==

Rossdonaldson1: Text replacement - "HA" to "headache"

2016-07-31T12:34:50Z

Text replacement - "HA" to "headache"

← Older revision		Revision as of 12:34, 31 July 2016
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	*Female predominance (up to 80-90%)		*Female predominance (up to 80-90%)
	*Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>		*Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>
	*Viral like prodrome (HA, low-grade fever, malaise)		*Viral like prodrome (headache, low-grade fever, malaise)
	*Psychiatric manifestations (anxiety, agitation, bizarre behavior, hallucinations, etc)and or decreased level of consciousness <ref name="clinical"></ref>		*Psychiatric manifestations (anxiety, agitation, bizarre behavior, hallucinations, etc)and or decreased level of consciousness <ref name="clinical"></ref>
	*Dyskinesia, movement disorders and increased rigidity		*Dyskinesia, movement disorders and increased rigidity

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T21:27:33Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 21:27, 23 July 2016
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	{{AMS DDX}}		{{AMS DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Diagnosis confirmed by detection of antibodies to NR1 subunit of NMDAR in CSF or serum (typically send-out lab)		*Diagnosis confirmed by detection of antibodies to NR1 subunit of NMDAR in CSF or serum (typically send-out lab)
	*[[LP]]: CSF lymphocytic pleocytosis or oligoclonal bands (can be normal initially)		*[[LP]]: CSF lymphocytic pleocytosis or oligoclonal bands (can be normal initially)

Neil.m.young: Text replacement - "* " to "*"

2016-07-06T03:51:10Z

Text replacement - "* " to "*"

← Older revision		Revision as of 03:51, 6 July 2016
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	==Clinical Features==		==Clinical Features==
	===History===		===History===
	* Female predominance (up to 80-90%)		*Female predominance (up to 80-90%)
	* Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>		*Predominantly in children and young adults, however can be found at any age<ref name="clinical">Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011 Jan;10(1):63-47. PMID: 21163445</ref><ref>Armangue T, Petit-Pedrol M, Dalmau J Autoimmune Encephalitis in Children. J Child Neurol. 2012 Nov;27(11):1460-9. PMID: 2293555</ref>
	* Viral like prodrome (HA, low-grade fever, malaise)		*Viral like prodrome (HA, low-grade fever, malaise)
	* Psychiatric manifestations (anxiety, agitation, bizarre behavior, hallucinations, etc)and or decreased level of consciousness <ref name="clinical"></ref>		*Psychiatric manifestations (anxiety, agitation, bizarre behavior, hallucinations, etc)and or decreased level of consciousness <ref name="clinical"></ref>
	* Dyskinesia, movement disorders and increased rigidity		*Dyskinesia, movement disorders and increased rigidity
	* Autonomic instability: hyperthermia, tachy/brady,BP fluctuations, hypoventilation		*Autonomic instability: hyperthermia, tachy/brady,BP fluctuations, hypoventilation
	* Lethargy, seizures		*Lethargy, seizures
	===Physical===		===Physical===
	* Abnormality in vitals as above, rarely may find abdominal mass		*Abnormality in vitals as above, rarely may find abdominal mass
	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Viral encephalitis]]		*[[Viral encephalitis]]
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	==Diagnosis==		==Diagnosis==
	* Diagnosis confirmed by detection of antibodies to NR1 subunit of NMDAR in CSF or serum (typically send-out lab)		*Diagnosis confirmed by detection of antibodies to NR1 subunit of NMDAR in CSF or serum (typically send-out lab)
	* [[LP]]: CSF lymphocytic pleocytosis or oligoclonal bands (can be normal initially)		*[[LP]]: CSF lymphocytic pleocytosis or oligoclonal bands (can be normal initially)
	* EEG: to rule out seizure with movement disorders		*EEG: to rule out seizure with movement disorders
	* MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions		*MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions
	* Pelvic US or CT or MRI to evaluate for associated ovarian teratoma		*Pelvic US or CT or MRI to evaluate for associated ovarian teratoma

	==Management==		==Management==
	* Resection of tumor if there is an associated mass<ref name="treatment">Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013 Feb;12(2):157-65. PMID: 23290630		*Resection of tumor if there is an associated mass<ref name="treatment">Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013 Feb;12(2):157-65. PMID: 23290630
	</ref>		</ref>
	*Glucocorticoids<ref name="treatment"></ref>		*Glucocorticoids<ref name="treatment"></ref>
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	*Second line rituximab and cyclophosphamide<ref name="treatment"></ref>		*Second line rituximab and cyclophosphamide<ref name="treatment"></ref>
	==Disposition==		==Disposition==
	* Admission with Neurology Consult		*Admission with Neurology Consult
	==See Also==		==See Also==
	*[[Altered mental status]]		*[[Altered mental status]]

Ostermayer: Text replacement - "Category:Tox" to "Category:Toxicology"

2016-03-22T16:23:24Z

Text replacement - "Category:Tox" to "Category:Toxicology"

← Older revision		Revision as of 16:23, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Tox~~]]		[[Category:Toxicology]]
	[[Category:Neurology]]		[[Category:Neurology]]

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:19Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:14, 22 March 2016
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	[[Category:Tox]]		[[Category:Tox]]
	[[Category:~~Neuro~~]]		[[Category:Neurology]]

NicoleZadzilka: fixed spelling of teratoma

2016-01-14T15:28:24Z

fixed spelling of teratoma

← Older revision		Revision as of 15:28, 14 January 2016
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	* EEG: to rule out seizure with movement disorders		* EEG: to rule out seizure with movement disorders
	* MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions		* MRI brain: normal or transient FLAIR or contrast enhancing abnormalities in cortical or subcortical regions
	* Pelvic US or CT or MRI to evaluate for associated ovarian ~~tetratoma~~		* Pelvic US or CT or MRI to evaluate for associated ovarian teratoma

	==Management==		==Management==