[A case of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis presenting with characteristic symptoms such as altered sense of time, visual distortion and hallucinations].

Authors

Keigo Nakamura, Akihito Koseki, Naoki Morishita, Youji Suzuki, Naoki Sakai, Takahiro Iizuka

Published in

Rinsho shinkeigaku = Clinical neurology. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

A previously healthy 20-year-old woman was admitted to our hospital because of psychobehavioral alterations, generalized seizure, and post-ictal drowsiness. Six weeks before this admission, depression developed, followed by dysgeusia, anorexia, hearing loss, auditory hallucinations, logoclonia, and generalized seizures, leading to the first hospitalization. On admission, the temperature was 37°C. She was awake, well oriented, but had logoclonia. Brain MRI and electroencephalography (EEG) were both unremarkable, but cerebrospinal fluid (CSF) analysis revealed 7 cells/μl. After admission, she began to exhibit a variety of psychosomatic symptoms, such as altered sense of time, visual disturbances, visual hallucinations, and phonological paraphasia, and logoclonia. On day 4 she was once discharged home, but 4 days later, she was re-admitted to the hospital because of recurrence of seizure. An EEG recorded on day 1 revealed epileptiform discharges arising from the Cz and Pz. CSF-restricted oligoclonal bands were detected. Because of the suspicion of autoimmune encephalitis, the patient was treated with 3 cycle of intravenous high-dose methylprednisolone and 4 rounds of plasma exchanges, resulting in resolution of seizures; however, cognitive impairment and an altered sense of time persisted. Antibody test results came back positive for GluN1 (estimated CSF antibody titers, 1:4) with neuropil staining on rat brain immunohistochemistry, confirming the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, but no myelin oligodendrocyte glycoprotein antibodies were detected. No ovarian teratoma was found. Following rituximab therapy, cognitive function improved. This case highlights that a forme fruste of anti-NMDAR encephalitis can be attributed to low titers of GluN1 antibodies, and cause a variety of psychosomatic symptoms, without development of typical spectrum of anti-NMDAR encephalitis. Careful assessment is required for appropriate diagnosis and treatment.

PMID:
42572288
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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