Objective – This case study describes the neuropsychological results of a 21 year old, Caucasian, single, right-handed female college student who was diagnosed with limbic encephalitis associated NMDA receptor antibodies in May, 2010.
Method – NMDA receptor is a specific ionotropic glutamate receptor (N-methyl D-aspartate). Syndromes associated with this type of encephalopathy often initially manifest with psychiatric symptoms.
GE’s initial symptoms of paranoia and other associated psychotic features warranted a 2 week inpatient psychiatric admission in January, 2009. Her response to treatment was deemed clinically marginal. In March, 2010, she developed an acute onset of physical symptoms including dysarthria and dominant RUE weakness. A cerebral MRI was noteworthy for periventricular white matter lesions which initially suggested multiple sclerosis (MS). Cerebral spinal fluid (CSF) analysis was negative. She was emergently admitted to a tertiary university hospital for neurological consultation and observation. During that period, she developed a generalized seizure and was briefly placed on mechanical ventilation. Pelvic scans were negative for ovarian teratoma, a precursor for the syndrome. She was eventually diagnosed with this form of encephalitis in May, 2010 and treated accordingly with chemotherapy. She was referred for baseline neuropsychological consultation.
Results – Results of GE’s neuropsychological evaluation (10/5/10) suggested subtle adaptive impairments as indicated by scores on standardized neuropsychological indices (Halstead Impairment Index 0.4, GNDS 14). Primary deficits were in areas of sustained attention/concentration, delayed visual memory, tactual localization memory, and bilateral UE grip strength.
Conclusion – This case study underscores the importance of obtaining baseline neuropsychological data in individuals diagnosed with limbic encephalitis associated with NMDA receptor antibodies to assist in developing treatment recommendations with specific emphasis toward educational reintegration.