Disclosures: Aaron Bolds, MD, MBA: No financial relationships or conflicts of interest

Case Description: A previously healthy female presented with mutism, personality changes, and athetosis. Initial workup included an unrevealing MRI brain. EEG revealed theta and delta slowing without seizure-like activity. Lumbar puncture revealed increased NMDA-Ab titer, leading to the diagnosis of Anti-NMDA receptor encephalitis, a type of brain inflammation secondary to antibodies. Malignancy work-up was negative, although malignancy is etiology in 25% of cases. Hospital course was complicated by worsening aggression with dyskinesia. There was also auto-amputation of her tongue by biting, which required the use of paralytics for life saving measures and emergency surgical reconstruction by ENT with loss of anterior portion. Acute medical management consisted of a combination of intravenous methylprednisolone and immunoglobulin, transitioned to Rituximab, cyclophosphamide and Amantadine. Acute rehab was appropriate given the functional and cognitive deficits limiting mobility and ADLs.

Setting: Tertiary inpatient rehabilitation unit

Patient: A 28-year-old woman with Anti-N-methyl-D-aspartate receptor (NMDA) encephalitis Assessment/

Results: During rehab, patient’s cognitive function improved as Amantadine was up titrated. Rehab course was complicated by tachycardia likely secondary to dysautonomia, managed with Propranolol. At outpatient follow up, the patient’s cognitive function improved significantly; however, she continued to experience symptoms of paranoia and delusions, hindering her return to work.

Discussion: This diagnosis should be considered in patients presenting with new onset behavioral and movement disturbances, especially in young females. In this case, Amantadine was used for both movement problems and neurostimulation. It is important to consider Amantadine as a NMDA receptor antagonist and close monitoring due to its potential to exacerbate psychiatric symptoms.

Conclusion: Early rehabilitation is vital to address underlying cognitive and motor deficits in patients with anti-NMDA receptor encephalitis. This case outlines the role of the physiatrist in the acute setting and subsequent visits to address any sequelae of disease that may affect the return to baseline functioning.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-anti-n-methyl-d-aspartate-receptor-encephalitis-gets-your-tongue-a-case-report/