Differentiating Anti-NMDA receptor encephalitis from other diseases
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Differentiating Anti-NMDA receptor encephalitis from Other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;AE Dheeraj Makkar, M.D.[2]
Overview
In the differential diagnosis of anti-NMDA encephalitis, other autoimmune encephalitides with specific antibody associations should be considered, including those associated with antibodies against AMPA receptors, GABA-B receptors, LGI1, Caspr2, and MOG. Clinical and serological evaluations are crucial for accurate diagnosis and appropriate management.
Differentiating Anti-NMDA Receptor Encephalitis from other Diseases
| Antigen | NMDA receptor NR1 | Lgil | CASPR2 | AMPA receptor | GABA B receptor | Glycine receptor | MgluR5
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| Age(median)/gender female : male | 0·6–85 (21) 4:1 | 30–80 (60) 1:2 | 46–77 (60) 1:4 | 38–87 (60) 9:1 | 24–75 (62) 1:1 | 5–69 (43) 6:5 | 46, 15 1:1 |
| Clinical syndrome | 1.Prodromal Syndrome
2. Psychiatric Syndrome, seizures, amnesia 3.Movement disorders catatonia, autonomic instability, |
Limbic encephalitis, tonic or facio-brachial dystonic seizures,
myoclonus
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Morvan Syndrome, encephalitis, neuromyotonia | Limbic encephalitis, psychiatric syndrome | Limbic encephalitis | Encephalomyelitis with rigidity and myoclonus, hyperekplexia, stiff-person syndrome,
(retinopathy) |
Limbic encephalitis, myoclonus |
| MRI T2/FLAIR hyperintensities, medial temporal | 25% | 80% | 40% | 90% | 70% | 10% | 50% |
| CSF pleocytosis or Oligoclonal Bands | 95% | 40% | 25% | 90% | 90% | some oligoclonal bands | 2/2 only cases reported and present in them
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ocb: oligoclonal bands; EEG: electroencephalograph; NMDA: N-methyl-D-aspartate; AMPA: α-amino-3-hydroxy-5-methyl-4-isoxazol-propionic acid; GABA: γ-amino-butyric acid receptor; CASPR2: contactin-associated protein-like 2; Lgi1: leucine-rich, glioma-inactivated 1; mGluR5: metabotrophic glutamate receptor 5.
Other etiologies causing Anti NMDA encephalitis like features
| Differential diagnosis
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| Bacterial and viral infections of the brain | Herpes simplex virus type 1, Human herpes virus type 6, Enterovirus, Mycoplasma
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| Autoimmune-associated encephalitis | PANDAS, Sydenham chorea, Hashimoto encephalopathy, Rasmussen encephalitis, Encephalitis lethargica
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| Autoimmune synaptic receptor encephalitides | Neuronal antibodies to GABA, AMPA, and LGI1receptors |
| CNS vasculitis | Primary CNS angiitis, Secondary (due to chronic infection, inflammatory processes) |
| Demyelinating disorders | Acute disseminated encephalomyelitis, Neuromyelitis optica |
| Medication Overdose | Ketamine, Phencyclidine |
References
- ↑ Nichols TA (2016). "Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community". Ment Health Clin. 6 (6): 297–303. doi:10.9740/mhc.2016.11.297. PMC 6007532. PMID 29955485.