Anti-NMDAR encephalitis in 10-year-old girl: Sanglah Hospital, Bali, Indonesia

I Gusti Ngurah Made Suwarba

doi:10.29332/ijhs.v5n1.600

Authors

I Gusti Ngurah Made Suwarba
suwarbangurah@yahoo.co.id
Department of Child Health Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia

Keywords:

anti-NMDAR, children, encephalitis, neuropsychiatry, syndrome

Abstract

Anti-NMDAR encephalitis is a central nervous system (CNS) disease involving dysfunction of the autoimmune system. Anti-NMDAR encephalitis is an immune-mediated disease characterized by a complex neuropsychiatric syndrome and the presence of CSF antibodies against the GluN1 subunit of the NMDAR. The diagnosis was by history taking, physical examination, and antibody NMDAR for definitive diagnosis. Principal management is starting therapy earlier may lead to better outcomes. A 10-year-old girl was admitted to Sanglah Hospital, with a complaint of seizure with the characteristic of the seizure was head-turning to the left side then continue to stiff extremities and body, involved stiffening and jerking, both eyes glared up, and unconscious. A Head CT scan showed no signs of hemorrhage, intracerebral or intracerebellar space-occupying lesion, hypertrophy chance nasal inferior bilateral, blurring in grey-white matter junction regio right parietal lobus with narrowing of right lateral ventricle, suspected right hemisphere edema. MRA showed no signs of the infarct, hemorrhage, or space-occupying lesion, with normal anterior and posterior arterial cerebri system. Anti-NMDAR serum was positive. The patient was treated with high-dose methylprednisolone and planned to get cyclophosphamide. Anti-NMDAR encephalitis is a disease with the challenging diagnosis of neuropsychiatric syndrome in children.

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