Behavioral problem, Acute Confusional state and Mutism as Presentation of NMDA Encephalitis


  • Jawad Ahmad Wasif Department of Pediatrics, Letterkenny University Hospital Donegal-Ireland
  • Syed Muhammad Hur Abbas Khyber Medial College Peshawar
  • Gulsam Bashir Khyber Medial College Peshawar


Encephalitis, NORSE, NMDA



Anti-N-methyl D-aspartate (NMDA) receptor (anti-NMDAR) encephalitis is caused by immunoreactivity against the NR1 subunit of the NMDA receptor. We present the case of an 18-year-old young girl with that presented to us with behavioral problem, acute confusional state and mutism. After a detailed history and a thorough clinical examination the autoimmune encephalitis antibodies profile were sent. This came positive for NMDA receptor and negative for CASPR-2, Type AMPA1/2, LGI-1, DPPX, and GABAB receptor antibodies. The patient was started on corticosteroids, azathioprine and procyclidine. She was sent home on immune suppressive therapy and called after 4 weeks for follow up. Upon follow up her mutism was gone but the behavioral issue was not significantly improved. Steroids induced psychosis was also observed. She was started on Rituximab with improvement in her behavior. Acute confusional state and behavioral illness preceded the diagnosis of NMDA Encephalitis. The diagnosis of autoimmune encephalitis should be considered a top differential in relapsing patients as it has a very wide range of presentation. Prompt diagnosis and early treatment are the need of the hour as the ramifications of a mis or missed diagnosis could be detrimental


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How to Cite

Wasif, J. A., Abbas, S. M. H., & Bashir, G. (2020). Behavioral problem, Acute Confusional state and Mutism as Presentation of NMDA Encephalitis. THE STETHO, 1(1), 7-9. Retrieved from



Case Reports