Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is increasingly being recognised to be associated with protean neuropsychiatric manifestations. Anti-NMDAR encephalitis is considered to be the most common amongst the autoimmune-mediated encephalitic disorders. It is caused by the autoantibodies against GluN1 subunits of N-methyl-D-aspartate (NMDA) receptor and manifests with prominent psychiatric symptoms, especially during the initial phase of illness. Literature anti-NMDAR encephalitis presenting with postpartum psychosis is scant. In this report, we present a 28-year-old lady with postpartum psychosis as presenting manifestation of anti-NMDAR encephalitis and discuss the neuropsychiatric manifestations of this emerging entity.
References
Bergink V, Armangue T, Titulaer MJ, Markx S, Dalmau J, Kushner SA (2015) Autoimmune encephalitis in postpartum psychosis. Am J Psychiatry 172(9):901–908. https://doi.org/10.1176/appi.ajp.2015.14101332
Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7(12). Elsevier):1091–1098. https://doi.org/10.1016/S1474-4422(08)70224-2
Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10(1):63–74. https://doi.org/10.1016/S1474-4422(10)70253-2
Doden T, Sekijima Y, Ikeda J, Ozawa K, Ohashi N, Kodaira M, Hineno A, Tachibana N, Ikeda S-i (2017) Postpartum anti-N-methyl-D-aspartate receptor encephalitis: a case report and literature review. Intern Med 56(3):357–362
Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, Belle S et al (1995) A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 10(5):367–377. https://doi.org/10.1002/gps.930100505
Höftberger R (2015) Neuroimmunology: an expanding frontier in autoimmunity. Front Immunol 6:206. https://doi.org/10.3389/fimmu.2015.00206
Javitt DC, Zukin SR (1991) Recent advances in the phencyclidine model of schizophrenia. Am J Psychiatry 148(10):1301–1308. https://doi.org/10.1176/ajp.148.10.1301
Kayser MS, Dalmau J (2011) Anti-NMDA Receptor Encephalitis in Psychiatry. Curr Psychiatr Rev 7(3). Bentham Science Publishers):189–193
Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J (2013) Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-D-aspartate receptor encephalitis. JAMA Neurol 70(9):1133–1139. https://doi.org/10.1001/jamaneurol.2013.3216
Koksal A, Baybas S, Mutluay B, Altunkaynak Y, Keskek A (2015) A case of NMDAR encephalitis misdiagnosed as postpartum psychosis and neuroleptic malignant syndrome. Neurol Sci 36(7):1257–1258. https://doi.org/10.1007/s10072-014-1966-3
Lee SK, Lee ST (2016) The laboratory diagnosis of autoimmune encephalitis. J Epilepsy Res 6(2):45–52. https://doi.org/10.14581/jer.16010
Mann AP, Grebenciucova E, Lukas RV (2014) Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges. Ther Clin Risk Manag 10(July):517–525. https://doi.org/10.2147/TCRM.S61967
Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR (2000) A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology 55(11):1613–1620. https://doi.org/10.1212/01.wnl.0000434309.85312.19
Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D (2012) Extreme Delta Brush. Neurology 79(11):1094–1100. https://doi.org/10.1212/WNL.0b013e3182698cd8
Shaaban HS, Choo HF, Sensakovic JW (2012) Anti-NMDA-receptor encephalitis presenting as postpartum psychosis in a young woman, treated with rituximab. Ann Saudi Med 32(4):421–423. https://doi.org/10.5144/0256-4947.2012.421
Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 12(2):157–165. https://doi.org/10.1016/S1474-4422(12)70310-1
Tonomura Y, Kataoka H, Hara Y, Takamure M, Naba I, Kitauti T, Saito K, Ueno S (2007) Clinical analysis of paraneoplastic encephalitis associated with ovarian teratoma. J Neuro-Oncol 84(3):287–292. https://doi.org/10.1007/s11060-007-9372-9
Yu AYX, Moore FGA (2011) Paraneoplastic encephalitis presenting as postpartum psychosis. Psychosomatics 52(6):568–570. https://doi.org/10.1016/j.psym.2011.01.043
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Reddy, M.S.S., Thippeswamy, H., Ganjekar, S. et al. Anti-NMDA receptor encephalitis presenting as postpartum psychosis—a clinical description and review. Arch Womens Ment Health 21, 465–469 (2018). https://doi.org/10.1007/s00737-018-0816-3
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DOI: https://doi.org/10.1007/s00737-018-0816-3