Anti-NMDAR Encephalitis With Serial Negative MRI Findings: An Evaluation Using Autoimmune Psychosis Criteria.
Case reports in neurological medicine January 1, 2025 Satoshi Saito, Go Taniguchi, Chihiro Nakata et al.
A 15-year-old boy with sudden seizures and worsening psychiatric symptoms—including reduced reactivity, language deterioration, and catatonia—was initially misdiagnosed with a psychiatric disorder because repeated MRI scans were normal. Using autoimmune psychosis criteria, doctors suspected autoimmune encephalitis, which was confirmed by detecting oligoclonal bands and anti-NMDAR antibodies in blood and spinal fluid. Steroid pulse therapy led to significant improvement. The case shows that anti-NMDAR encephalitis can mimic primary psychiatric conditions and that autoimmune psychosis criteria, which consider features like subacute onset, catatonia, cognitive dysfunction, altered consciousness, and seizures, can aid diagnosis even when standard biomarkers are negative.