Persistent Central Hypoventilation Following Probable Remission from Anti-N-methyl-D-aspartate Receptor Encephalitis
Bibliographic record
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis classically presents with prominent psychiatric disturbances, seizures, and cognitive dysfunction.Central hypoventilation is seen in 40-60% of adult patients within the first 2 months of illness.[1][2] Rarely occurring in patients with preserved consciousness, 3 central hypoventilation is usually associated with significant neuropsychiatric dysfunction, as the disease progresses to a catatonic-like state with depressed consciousness. 2 We report the case of a patient with anti-NMDAR encephalitis who, following an initial self-limited neuropsychiatric presentation, predominantly had persistent, and ultimately immunotherapy-responsive, central hypoventilation.A 48-year-old woman was admitted in September 2020 to the McGill University Health Center (Montreal, QC, Canada) for hypercapnic respiratory failure, following 7 months of worsening idiopathic central sleep apnea.Her past medical history included a left oophorectomy in 1996 for a large painful ovarian mass, which was defined as a mature teratoma and serous cystadenoma on pathology.Her initial presentation to Neurology goes back to July 2019, when she presented to the emergency department (ED) with an abdominal rash, fever (38.0°C), transaminitis (alanine aminotransferase 320 U/L) and lymphopenia (absolute lymphocyte count 0.72 * 10 9 /L) following days of disorientation, word-finding difficulties, and psychomotor slowing.A lumbar puncture revealed lymphocytic pleocytosis (99 leukocytes/μL), normal protein and glucose, negative bacterial culture, Herpes Simplex Virus 1-2, and Enterovirus polymerase chain reaction (PCR).Extensive infectious and neoplastic work-up, including whole body PET scan, was otherwise unrevealing.Brain MRI showed nonspecific supratentorial white matter abnormalities.Intracellular antineuronal antibodies were tested and not detected in her serum, but cell-surface autoimmune encephalitis antibodies, including anti-NMDAR, were not tested given her multisystemic presentation and spontaneous improvement.While hospitalized, she had one episode of nocturnal oxygen desaturation (76%), which was not further investigated.After 2 weeks, she was discharged with a diagnosis of "viral encephalitis", after normalization of systemic disturbances and cognition.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".