NMDA-Receptor Encephalitis: An Unsual Case of Refractory Status Epilepticus (P6.286)
Bibliographic record
Abstract
OBJECTIVE: We report a case of NMDA receptor encephalitis in a young man with early refractory status epilepticus and atypical radiological findings. BACKGROUND: Anti-NMDA receptor encephalitis is an autoimmune disorder characterized by psychiatric symptoms followed by dyskinesia, altered consciousness, and seizures due to antibodies to the NR1-NR2B heterodimer of NMDA receptor. On imaging, it typically presents with T2 hyperintensities in mesial temporal lobes, cerebral cortex and basal ganglia. We present a case with a dramatic clinical evolution and novel imaging findings. DESIGN/METHODS: Case report and review of imaging. RESULTS: A 29-year-old male of Carribean origin presented with 2 months of mood disturbance followed by new partial-complex seizures, facial dyskinesia and choreo-athetotic movements. His initial MRI showed subtle T2-hyperintensities in both mesial temporal lobes, without enhancement. The diagnosis of NMDA-receptor encephalitis was suspected and subsequently confirmed after CSF antibody detection. Prior to diagnostic confirmation, he developed status epilepticus refractory to multiple anti-convulsants, and concomitant signs of herniation. A repeated MRI showed increased T2-signal abnormalities of both thalami and mesencephalon, with cerebellar involvement and transtentorial and transforaminal herniation. Restricted diffusion was documented in the cerebellar cortex, thalami, putamina and caudate. He was treated with IV corticosteroids and hypertonic fluid which reversed the herniation, and halted the seizures. Follow-up imaging showed near resolution of the restricted diffusion and the signal abnormalities, except for persistent abnormalities of the hippocampal gyri, and posterior thalami. The patient remained clinically unchanged. CONCLUSIONS: To our knoweldge, this is the first case report of uncal and tonsillar herniation in the context of NMDA receptor encephalitissecondary to atypical, predominant cerebellar involvement in the context of NMDA receptor encephalitis. This case highlights a life-threatening manifestation that physicians might encounter, and also a possible role for high dose IV corticosteroids as an adjunct treatment in NMDA encephalitis with brain edema and seizures.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".