Korean J Schizophr Res.  2017 Apr;20(1):23-27. 10.16946/kjsr.2017.20.1.23.

A Case of Catatonia Later Diagnosed with NMDA Receptor Encephalitis

• Lee S
• Chon MW
• Lee J
• Kim CY

• KMID: 2387929
• DOI: http://doi.org/10.16946/kjsr.2017.20.1.23

Abstract

We report a case of a young female patient with catatonic features who later turned out to be suffering from an anti-NMDA (N-methyl-D-aspartate)-receptor-antibody encephalitis. A previously healthy 21-year-old woman was admitted to psychiatric inpatient care presenting with acute psychotic behavior with catatonic features. Laboratory tests of serum and CSF (Cerebrospinal fluid), EEG (Electroencephalogram), brain MRI (Magnetic Resonance Imaging) were unremarkable except vague slow wave on EEG. However, subtle cognitive impairment at the bedside examination suggested further imaging studies to rule out possible organic etiology like autoimmune encephalitis. Brain PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) suggested probable inflammation in the brain. In case of autoimmune encephalitis, given the severity of symptoms and worsening course, steroid pulse therapy was initiated promptly even though the diagnosis was not confirmed but presumed at that time. She recovered completely with steroid therapy. Later her disease turned out to be anti-NMDA-receptor-antibody encephalitis by the antibody test which was not available at the time of admission. Psychiatrists need to be aware of autoimmune encephalitis like anti-NMDA-receptor-antibody encephalitis in the differential diagnosis of acute psychosis with catatonic features. Subtle cognitive impairment which tends to be overlooked due to catatonic features might be a clue to suspect the organic etiology.

Keyword

Catatonia; Cognitive impairment; Anti-NMDA-receptor-antibody encephalitis

MeSH Terms

Brain
Catatonia*
Cognition Disorders
Diagnosis
Diagnosis, Differential
Electroencephalography
Encephalitis*
Female
Glycogen Storage Disease Type VI
Humans
Inflammation
Inpatients
Magnetic Resonance Imaging
N-Methylaspartate*
Psychiatry
Psychotic Disorders
Tomography, Emission-Computed, Single-Photon
Young Adult
N-Methylaspartate

Figure

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  Fig. 1 Bedside examination on hospital day 8. The patient showed perseveration in clock drawing and tracing task.

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  Fig. 2 SPECT image on hospital day 9. Mildly decreased perfusion of right frontal & temporal cortex.

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  Fig. 3 PET image on hospital day 9. Hypermetabolic signal on right temporo-parietal cortex.

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