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A case of late-onset and long term of anti-NMDA-receptor encephalitis in a 50-year-old patient with culturally acceptable psychosis and cognitive decline

Published online by Cambridge University Press:  13 August 2021

Y. Palchikova ,
N. Zalutskaya ,
N. Gomzyakova ,
V. Mikhailov  and
N. Ananyeva
Y. Palchikova*
Affiliation:
Geriatric Psychiatry, V. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY, St.Petersburg, Russian Federation
N. Zalutskaya
Affiliation:
Geriatric Psychiatry, V. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY, St.Petersburg, Russian Federation
N. Gomzyakova
Affiliation:
Geriatric Psychiatry, V. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY, St.Petersburg, Russian Federation
V. Mikhailov
Affiliation:
Of Epilepsy, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russian Federation
N. Ananyeva
Affiliation:
Radiology, V. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY, St. Petersburg, Russian Federation
*
*Corresponding author.

Abstract

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Introduction

Anti-NMDA-receptor encephalitis is a severe rare acute form of encephalitis caused by an autoimmune process with the synthesis of autoantibodies to the glutamate receptors. The average age of onser is estimated to be 23-25 years. A typical clinical picture consist of prodromal, psychotic, areactive, hyperkinetic phases, and a phase of gradual regression of symptoms. The disease usually lasts for a several weeks with spontaneous recovery or fatal outcome and caused by neoplastic process. Our case demonstrates that the course of anti-NMDAR encephalitis is possible at more mature age in the form of a long process with cultural features, without significant catadrome, inflammation and associated neoplastic process.

Objectives

50-year-old Buddhist Buryat woman with complaints about hypomnesia, anosmia and dissomnia. The disease began with impaired consciousness, disorientation, seizures and memory loss 4 years ago. Then after a visit of Lama, the symtoms described above spontaneously reduced and schizophrenia-like psychosis developed (voice of Lama in the head, a belief in the existence of super-powers, disorganized behavior), mild neurological and severe neurocognitive symptoms, weight loss, intolerance to antipsychotics in minimal daily doses.

Methods

Examination included: CBC, metabolic panel, coagulogram, tumor markers, CSF, MRI, PET, specialists.

Results

CBC, metabolic blood analysis, tumor markers - within the reference values. CSF: cytosis 9/3, glucose 5.5 mmol/l, Pandi++, Nonnet-Apeltau+, antibodies to the NMDA receptor - 8. MRI: signs of the consequences of encephalitis. PET: no signs of metabolic activity of the malignant process.

Conclusions

The diagnosis of anti-NMDA-receptor-encephalitis was confirmed by the laboratory and clinical criteria despite unususal course and age. The trigger role of herpes is possible, but not verified.

Disclosure

No significant relationships.

Keywords

Anti-N-Methyl-D-Aspartate Receptor Encephalitiscultural psychiatryHerpes Simplexpsychotic disorder
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S681
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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