Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A diagnosis obscured by concomitant recreational drug use

Authors

Paige Lester MS II, Marshall University, Joan C. Edwards School of MedicineFollow
Adam M. Franks MD, Marshall University Joan C. Edwards School of MedicineFollow
William Rollyson MS IV, Marshall University, Joan C. Edwards School of MedicineFollow
Jenna K. Barbour MD, Marshall University, Joan C. Edwards School of MedicineFollow
Matthew B. Curry MD, Marshall University Joan C. Edwards School of MedicineFollow

Author Credentials

NA

Author ORCID Identifier

Adam M. Franks, MD ORCID# 0000-0002-3710-6138

William Rollyson, MD ORCID# 0000-0002-5493-2423

Keywords

NMDA receptors, Autoimmune encephalitis, Drug use, Physician bias

Disciplines

Family Medicine | Medicine and Health Sciences | Neoplasms | Nervous System Diseases | Neurology

Abstract

Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in the case of atypical presentations or those with past or current substance use disorder. Early identification and treatment are essential to good outcomes and minimal sequalae at two years. Therefore, it is essential to consider aNMDAre with the symptom profile regardless of patient age, sex, race, or clinical disorder. Below is detailed the difficulty in diagnosing aNMDAre in a 32-year-old white male with a history of methamphetamine, opioid, benzodiazepine, and marijuana use.

Recommended Citation

Lester P, Franks AM, Rollyson W, Barbour JK, Curry MB. Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A diagnosis obscured by concomitant recreational drug use. Marshall J Med. 2021; 7(3): 18 DOI: https://doi.org/10.33470/2379-9536.1281.