Altered Mental Status in a Psychiatric Patient: A Case of Anti-NMDA Encephalitis Case Presentation: 29-year-old female with a history of Bipolar I Disorder, in remission off medication, presented to the Psychiatric Emergency Department with hyperactivity, insomnia, impulsive purchasing and audiovisual hallucinations for two weeks. The patient was admitted to psychiatry for treatment of mania with [...]

Case Presentation: A 19-year-old Caucasian female with hypothyroidism on synthroid was transferred from an outside emergency department for evaluation of psychosis. The patient’s father first noted changes in her behavior several months prior to admission when she developed rapid onset of excessive cleaning and organizing behavior, which was inconsistent with her prior messy behavior.  In [...]

Case Presentation: 17 year-old-male with a history of anti-NMDAr encephalitis three years prior presented with two days of confusion, agitation and insomnia. Associated symptoms included anorexia, blunted affect, slow movements and, though awake, refusal to respond or engage with others. Family also reported apparent hallucinations and associated aggression including biting. Neurologic examination with non-verbal patient, [...]

Case Presentation: An 18-year-old woman admitted to the hospital due to a new-onset tonic seizure lasting five minutes. She had recent history of flu-like illness a few weeks earlier. A review of systems revealed auditory and visual hallucinations. On physical examination, she was drowsy and disorientated to time only, but was following commands. Neurological examination [...]

Case Presentation: A 33-year-old woman presented with self-inflicted stab wounds to her neck and abdomen. Though she was initially alert and following commands, she was unwilling to provide a medical history and only shared that she had been experiencing headaches for three weeks prior to presentation.Labs were unremarkable, but CT scan on admission showed right [...]

Case Presentation: A 36-year-old female with no clear past medical history other than possible mood disorder presented after three days of decreased level of consciousness. Associated symptoms included body aches, fever, chills, nausea, vomiting, and headaches. The patient had been suffering from flu-like symptoms two weeks prior to presentation and was treated with antibiotics. The [...]

Case Presentation: A 23 year old female with a history of ovarian torsion, s/p ovarian cystectomy, presented to the emergency department in status epilepticus. Over the past week, the patient experienced a rapid deterioration in behavior associated with visual/auditory hallucinations, and panic attacks.  The patient was afebrile, blood pressure of 135/70, heart rate of 120, and [...]

Case Presentation: Autoimmune encephalitides comprise a rapidly evolving group of immune-mediated disorders characterized by inflammation of the brain parenchyma. Patients with this disorder manifest a wide spectrum of neurological and psychiatric presentations developing over days to months. One sub-type is anti-NMDAR-encephalitis, which is characterized by complex neuropsychiatric features and the presence of IgG antibodies against [...]

Case Presentation: Anti-NMDA Receptor Encephalitis is an uncommon diagnosis disguised behind the more common chief complaint of altered mentation. Although treatment options have been established for this disease, management of its behavioral manifestations remains complex. Here we discuss a 13-year-old female who presented with acute-onset altered mental status and atypical behavior. At symptom onset, a [...]

Case Presentation: A 32-year-old female was admitted after a seizure. Brain MRI was unremarkable and lumbar puncture yielded 133 white blood cells with 100% lymphocytes. Within a few days, refractory seizures occurred. Due to suspected autoimmune encephalitis, plasma exchange and high-dose steroids were started. Cerebral spinal fluid (CSF) studies returned with IgG antibody levels for [...]