Българско списание за психиатрия, 2020; 5(1): 17-23


Dobrinka Kalpachka1, Elka Misheva1, Rostislava Ruseva1, Emilian Gulev1, Kaloyan Guevara2, Rosen Kalpachki1

1University Hospital “Sv. Anna”, Department of Neurology – Sofia
2MHC “Prof. N. Shipkovenski” LTD – Sofia

Abstract. Autoimmune encephalitis is a rare neurological condition which requires complex clinical assessment and can be met in the actual neurological practice. Anti-NMDA receptor encephalitis is one type of autoimmune encephalitis that commonly affects young people, more often women, and can be provoked by a concomitant neoplastic disease with NMDA receptors expression or viral infection. More often its presentation is subacute within a few months, characterized by the simultaneous manifestation of neurological and psychiatric (psychotic) symptoms, as well as therapeutically resistant epileptic symptoms. The differential diagnosis most often includes viral encephalitis, limbic encephalitis, lethargic encephalitis, acute endogenous psychosis, intoxication with psychoactive substances. Immunological evidence and final diagnosis of anti-NMDA receptor encephalitis requires the establishment of anti-NMDA receptor antibodies in CSF, which currently can only be tested in laboratories abroad at this time. The low frequency of the disease, the complex clinical manifestation, the need to perform multiple serum and CSF immunological tests in differential diagnosis, the possibility of negative findings in imaging (including brain MRI), and the detection of specific antibodies in laboratories only outside the country, make the early diagnosis a challenging for the daily practice.

Key words: encephalitis, anti-NMDA-receptor, autoimmune, diagnosis, clinical case


Full text available here.