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243 - Anti-NMDA Receptor Encephalitis in Inpatient Rehabilitation: A Case Report

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JK

Joel Kopcow, BS

Medical Student
UCSF School of Medicine
San Francisco, California, United States

Co-Author(s)

RK

Ryan M. Kelly, MD

Resident Physician
McGaw Medical Center of Northwestern University/Shirley Ryan AbilityLab
Chicago, Illinois, United States
Leslie Rydberg, MD

Associate Professor, Clerkship Director, Associate Residency Program Director
Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Case Diagnosis: Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis

Case Description: A previously healthy 32-year-old woman with a history of obsessive compulsive disorder was hospitalized for three months with psychosis, agitation, seizures, respiratory failure, and a dermoid cyst leading to a diagnosis of anti-NMDA receptor encephalitis. She was transferred to acute inpatient rehabilitation following treatment with high-dose steroids, intravenous immunoglobulin, plasmapheresis, and oophorectomy. Multidisciplinary rehabilitation was implemented to improve cognitive and functional deficits. Significant functional gains were made at three weeks until disease recurrence required transfer for secondary treatment. Following one week of treatment, the patient returned to inpatient rehabilitation and made continued functional improvement until discharge to outpatient rehabilitation.

Discussions: Anti-NMDA receptor encephalitis is an autoimmune encephalitis characterized by a constellation of progressive psychiatric and neurologic symptoms. Recovery may take up to 18 months, with disease recurrence occurring in 10-30% of patients following treatment. On admission, this patient had notable cognitive and functional deficits. She required partial assistance with mobility and self-care, and moderate to maximum prompting for social cognition, expression, and comprehension. Multidisciplinary rehabilitation was implemented with marked improvement until seizure activity concerning for disease recurrence prompted urgent transfer. Auditory hallucinations and sleep disturbance were noted preceding the recurrence event. Following treatment, the patient returned to inpatient rehabilitation without loss of progress and with continued functional improvement before discharge to outpatient rehabilitation. At discharge, she was independent in all mobility tasks, supervision status for self-care, and progressed to minimal or moderate prompting requirements for cognitive tasks.

Conclusions: Anti-NMDA receptor encephalitis requires a multidisciplinary rehabilitation approach for cognitive and functional deficits. Disease recurrence presents a potential barrier to continuous rehabilitation but may not cause a loss of progress or limit functional recovery following treatment.