RT Journal Article
SR Electronic
T1 PM.100 A Rare Case of Anti-NMDA Receptor Encephalitis in Pregnancy
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP A53
OP A53
DO 10.1136/archdischild-2013-303966.181
VO 98
IS Suppl 1
A1 E Gaughan
A1 S Barry
A1 A McHugh
A1 F O’Donoghue
A1 K O’Rourke
A1 T Lynch
A1 A McCarthy
A1 J Sheehan
A1 P McKenna
YR 2013
UL http://fn.bmj.com/content/98/Suppl_1/A53.2.abstract
AB Anti-NMDA receptor encephalitis is a distinct disorder characterised by the predictable sequential development of symptoms; prodromal symptoms are initially noted, followed by prominent psychiatric symptoms, seizures, an unresponsive/catatonic state, hypoventilation, and involuntary orofacial-limb movements. This disorder usually affects young women with ovarian teratoma but may also affect women of any age or even men. We report the case of a 32 year old primigravid woman who developed psychosis with associated catatonia and autonomic dysfunction at 8 weeks gestation. Cranial imaging in the form of CT and MRI was normal. EEG showed slow waves and anti-NMDA receptor encephalitis was suspected. This was confirmed by the finding of serum anti-NMDA antibodies. Transvaginal Ultrasound and pelvic MRI suggested normal ovaries. She required admission to the High Dependency Unit for several weeks but eventually responded to plasma exchange, steroids, azathioprine, Intravenous immunoglobulin and antipsychotics. She had an Emergency LSCS at 32 weeks gestation for PPROM and delivered a healthy male infant. A mature cystic teratoma was found at caesarean section which was excised. Although being rare in pregnancy, anti NMDA encephalitis can respond to aggressive treatment and can be associated with good maternal and fetal outcomes. An awareness of this ‘new disease’ (first described in 2005) can lead to an occasional but dramatic surgical treatment of a psychotic illness.