Best Case Ever 28: Anti-NMDA Receptor Encephalitis

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 6 August 2014

⏱️ 14 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dr. David Carr presents his second of Carr's Cases. This series features some potentially life-threatening diagnoses that may be perceived as zebras, but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. This Best Case Ever is about Anti-NMDA Receptor Encephalitis, a diagnosis that was only discovered in 2005, and has only recently been recognized by the Emergency Medicine community. Anti-NMDA Receptor Encephalitis may mimic a first presentation of schizophrenia or Neuraleptic Malignant Syndrome. It may present with seizure, altered mental status, autonomic instability or movement disorder in the absence of drug exposure. When you are faced with any of these presentations and no other diagnosis seems to fit, do an LP and send the CSF for anti-NMDA receptor antibodies. The time-sensitive treatment is IVIG and steroids. Anti-NMDA receptor Encephalitis is a must know diagnosis for all emergency medicine practitioners. Learn how to pick up this important diagnosis by listening to Dr. Carr's Best Case Ever and following the links to further resources.

Transcript

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0:00.0	This is the second installment of Carr's Case's Best Case ever on EM Cases.
0:18.3	Take it away, Dr. Carr.
0:20.1	So 20-year-old guy, he's brought into the Emerge by EMS,
0:24.6	and the chief complaint is seizures. And this really is a story had gone back about 10 days.
0:30.3	A week prior to seeing him in the emergency department, he has this episode where he has this
0:35.2	facial twitching and maybe a seizure seizure and he's seen in a community
0:39.7	hospital and at that time he gets blood work he gets a CT everything's normal and he sent home with
0:47.7	EE EEG and neurofollow up as an outpatient and in the background of this patient is his roommate from university died two weeks ago.
0:59.0	So you can imagine where everyone's mind is. Roommate dies, acting strains. Talks, talks,
1:03.9	talks, psych, psych, psych. So this guy comes into the emerge. He has another witness seizure. Now,
1:09.1	a week ago, he's seen the community hospital. Now he comes to our hospital. He's got this seizure that lasted 30 seconds. And the seizure is really these episodes of twitching and facial twitching and maybe a little bit of shaking. But they're odd. They're not your, you know, this guy's seizing. We need you right now. That sort of season. Nurgis, is that a seizure? I don't know what that is. And he comes to emerge 369, heart rate 90 floor, blood pressure 146 over 81,
1:33.3	respirate 18, sats 99 with a normal sugar. He's a completely healthy guy. No meds, no past
1:40.2	medical history, no drugs of abuse. He's an A-plus student at a prestigious university.
1:46.1	He kind of has these twitches and they stop. And he's got this background of this talks
1:52.4	kind of maybe you've done something, maybe you haven't. So when you go to examine this guy,
1:56.5	he's drowsy. His GCS is 13, E3V4M6. Cranal nerves are normal. Pupas are normal. Strength is normal. His
2:06.4	neck is supple. There's no jolt. Tows are down going. Cerebellar testers. He examines completely
2:12.4	normal. You don't really know what to do with this guy. You got this weird story. So you cast a Broadnet.
2:18.9	You order CBC, lights, extended lights.
2:22.0	The resident ordered a thyroid test, your analysis.
2:24.8	They did a talk screen because, you know, what are we missing here?
2:28.8	Although I almost never do a talk screen.
	...

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