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Acute psychiatric illness in a young woman: an unusual form of encephalitis

Kaitlyn L Parratt, Martin Allan, Simon J G Lewis, Josep Dalmau, Gabor M Halmagyi and Judith M Spies
Med J Aust 2009; 191 (5): 284-286.
Published online: 7 September 2009

A 21-year-old woman was admitted to hospital with a diagnosis of acute psychotic mania, but developed, over approximately 6 weeks, seizures, delirium, catatonia, movement disorder and autonomic dysfunction. She was found to have antibodies to N-methyl-d-aspartate (NMDA) NR1–NR2 receptors in both serum and cerebrospinal fluid, consistent with anti-NMDA-receptor encephalitis, a severe, potentially lethal but treatment-responsive encephalitis often associated with ovarian tumour. With aggressive immunotherapy and bilateral oophorectomy, she recovered over a period of 14 months from her initial presentation. No ovarian tumour was identified. (MJA 2009; 191: 284-286)

A 21-year-old Indigenous woman was admitted to hospital with an acute change in mental state over the preceding 24 hours. She had become agitated, was pressured in speech and singing constantly. In the weeks before presentation, family members had noted increasingly disorganised behaviour and altered sleep patterns.

  • Kaitlyn L Parratt1
  • Martin Allan2
  • Simon J G Lewis1
  • Josep Dalmau3
  • Gabor M Halmagyi1
  • Judith M Spies1

  • 1 Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW.
  • 2 Concord Centre for Mental Health, Concord Hospital, Sydney, NSW.
  • 3 Department of Neurology, University of Pennsylvania, Philadelphia, Pa, USA.

Correspondence: drksharp@bigpond.net.au

Acknowledgements: 

Tests for antibodies to NR1–NR2 heteromers of the NMDA receptor, performed by Josep Dalmau, were supported in part by grants 2R56-CA-089054-O6A1 and RO1CA107192 from the United States National Institutes of Health.

Competing interests:

None identified.

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