NEUROMYELITIS OPTICA (AQUAPORIN-4 ANTIBODY-POSITIVE) WITH OVERLAPPING ANTI NMDAR ENCEPHALITIS

2021 ◽  
pp. 45-47
Author(s):  
Kirtan Nandlalbhai Patolia ◽  
Dixit Prakashbhai Dhorajiya ◽  
Nirav Ashokbhai Chavda ◽  
Jitendra. H. Parikh
Keyword(s):  
Neuromyelitis Optica ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Aquaporin 4 ◽  
Abnormal Behavior ◽  
Atypical Symptoms ◽  
Nmdar Encephalitis ◽  
Mog Antibodies ◽  
Demyelinating Disorders ◽  
Aquaporin 4 Antibody

Neuromyelitis Optica (NMO) is an inammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) or rarely with Anti -MOG antibodies (Myelin Oligodendrocyte Glycoprotein-IgG). Anti-NMDAR encephalitis classically presents with Neuro-psychiatric symptoms, including memory decits, seizures, frequent dyskinesia, autonomic dysfunction, reduced consciousness, and hypoventilation. Although rare, the coexistence of autoimmune encephalitis with demyelinating disorders should be considered in presence of atypical symptoms. We present a case of a patient with overlapping clinical features of NMOSD and Anti-NMDAR encephalitis presenting with difculty in voiding urine, constipation, abnormal behavior, and cognitive impairment as the chief ndings on presentation.

scholarly journals Anti-N-methyl-D-aspartate receptor encephalitis presenting as atypical psychosis in multiple sclerosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khushminder Chahal ◽  
Tara Endeman ◽  
Sarah Scapinello ◽  
Michal Sapieha
Keyword(s):  
Multiple Sclerosis ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Inpatient ◽  
Treatment Protocol ◽  
Autoimmune Encephalitis ◽  
Ovarian Teratoma ◽  
Atypical Symptoms ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

Abstract Background Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder which often presents with neuropsychiatric symptoms. A large proportion of cases are associated with an identifiable tumor, most commonly ovarian teratoma. However, recent literature has also described an overlap of anti-NMDAR encephalitis and demyelinating syndromes. Cases have been reported of anti-NMDAR encephalitis in patients with ADEM, optic neuritis, myelitis and multiple sclerosis. This link is considered rare, however has important clinical implications as treatments and prognosis may differ. Case presentation A 33-year-old female with a history of multiple sclerosis presented with new-onset neuropsychiatric symptoms. After substance-induced psychosis was ruled out, she was admitted to the medical ward for work up of psychosis secondary to multiple sclerosis. However, the consultation-liaison psychiatry service noted atypical symptoms which were concerning for autoimmune encephalitis. Admission to a psychiatric inpatient ward was deferred. Anti-NMDAR encephalitis was diagnosed with CSF analysis demonstrating lymphocytic pleocytosis and anti-NMDAR antibodies. In addition to first-line treatment of encephalitis with steroids, second-line immunotherapies were also implemented given the patient’s underlining demyelinating syndrome. The patient’s neurologic and psychiatric symptoms began to improve. Conclusions There is literature to demonstrate a possible connection between anti-NMDAR encephalitis and demyelinating syndromes. As such, autoimmune encephalitis should be considered in patients with multiple sclerosis presenting with atypical symptoms. Determining the correct diagnosis is crucial to inform the appropriate treatment protocol, and to improve prognosis.

Cortical oscillopsia without nystagmus, an isolated symptom of neuromyelitis optica spectrum disorder with anti-aquaporin 4 antibody

2011 ◽  
Vol 18 (2) ◽  
pp. 244-247 ◽  
Author(s):  
Sung-Min Kim ◽  
Ji-Soo Kim ◽  
Young Eun Heo ◽  
Hye-Ran Yang ◽  
Kyung Seok Park
Keyword(s):  
Spinal Cord ◽  
Neuromyelitis Optica ◽  
Spectrum Disorder ◽  
Aquaporin 4 ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Ocular Manifestation ◽  
Initial Manifestation ◽  
Ocular Symptoms ◽  
Head Tremor ◽  
Aquaporin 4 Antibody

Neuromyelitis optica (NMO), mainly affecting optic nerve and spinal cord, can also manifest diverse ocular symptoms due to brain abnormalities. We present a cortical oscillopsia without nystagmus or head tremor in a patient with neuromyelitis optica spectrum disorder (NMOSD) with anti-aquaporin 4 antibody. This rare ocular manifestation, which is easily underestimated owing to absence of the typical nystagmus, can be an initial manifestation of NMOSD.

Anti-aquaporin-4 Antibody-positive Definite Neuromyelitis Optica in a Patient With Thymectomy for Myasthenia Gravis

2012 ◽  
Vol 18 (2) ◽  
pp. 76-79 ◽  
Author(s):  
Kotaro Ogaki ◽  
Takashi Hirayama ◽  
Karina Chijiiwa ◽  
Jiro Fukae ◽  
Tsuyoshi Furuya ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Neuromyelitis Optica ◽  
Positive Definite ◽  
Aquaporin 4 ◽  
Aquaporin 4 Antibody

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms

2018 ◽  
Vol 49 (16) ◽  
pp. 2709-2716 ◽  
Author(s):  
Ronald J. Gurrera
Keyword(s):  
Nmda Receptor ◽  
Clinical Features ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Signs And Symptoms ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Unexplained Fever ◽  
Study Inclusion

AbstractBackgroundAnti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder.MethodsA systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains.ResultsTwo hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals.ConclusionsClinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

Transient increases in anti-aquaporin-4 antibody titers following rituximab treatment in neuromyelitis optica, in association with elevated serum BAFF levels

2011 ◽  
Vol 18 (7) ◽  
pp. 997-998 ◽  
Author(s):  
Ichiro Nakashima ◽  
Toshiyuki Takahashi ◽  
Bruce A.C. Cree ◽  
Ho Jin Kim ◽  
Chihiro Suzuki ◽  
...  
Keyword(s):  
Neuromyelitis Optica ◽  
Elevated Serum ◽  
Aquaporin 4 ◽  
Antibody Titers ◽  
Aquaporin 4 Antibody

Anti‐aquaporin‐4 antibody‐positive neuromyelitis optica spectrum disorder associated with central nervous system tuberculosis

2019 ◽  
Vol 11 (1) ◽  
pp. 40-44
Author(s):  
Enrique Gomez‐Figueroa ◽  
Christian Garcia‐Estrada ◽  
Adriana Casallas-Vanegas ◽  
Indhira Zabala-Angeles ◽  
Ramon Lopez-Martinez ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Neuromyelitis Optica ◽  
Spectrum Disorder ◽  
Aquaporin 4 ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Aquaporin 4 Antibody
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