Shingles and Manic Symptoms

Can J Psychiatry. 1992 May;37(4):271-3.



Encephalitis associated with herpes zoster: a case report and review.


McKenna KF, Warneke LB.


Alberta Heritage Foundation for Medical Research; Edmonton.
Comment in:
Can J Psychiatry. 1993 Nov;38(9):631.

This paper describes the case of a patient with a history of affective disorder who developed encephalitis associated with herpes zoster which presented as a delirium with prominent manic symptoms. Published reports of encephalitis following herpes zoster infections are reviewed. The diagnosis of herpes zoster-associated encephalitis should be suspected in individuals with changes in his or her mental state, an abnormal electroencephalogram and an abnormal cerebrospinal fluid examination which closely follow a cutaneous herpes zoster lesion.

PMID: 1611590 [PubMed - indexed for MEDLINE]

MY MYSTERIOUS LOST MONTH OF MADNESS: a case of Anti-nmdar Encephalitis Acute Psychosis

My mysterious lost month of madness

I was a happy 24-year-old suddenly stricken by paranoia & seizures. Was I going crazy?

By SUSANNAH CAHALAN
To read Susannah's article go here.




Susannah's story was featured on MSNBC's Medical Mysteries Series.

Dr. Souhel Najjar is the Neurologist who determined the underlying cause to Susannah's psychosis was anti-NMDAR Encephalitis.

Street: 223 East 34th Street
City/state/zip: New York NY 10016
Country: US
Email: Souhel.Najjar@nyumc.org
Phone: +1 646 558 0807
Fax: +1 646 358 7166

ANTI-NMDA RECEPTOR ENCEPHALITIS

Epileptic Disord. 2009 Sep;11(3):261-5. Epub 2009 Sep 7.
Complex partial status epilepticus revealing anti-NMDA receptor encephalitis.

Bayreuther C, Bourg V, Dellamonica J, Borg M, Bernardin G, Thomas P.

Department of Neurology, University of Nice Sophia-Antipolis, Pasteur Hospital, Nice, France.
Encephalitis with anti-NMDA receptor antibodies is a recently-recognised form of paraneoplastic encephalitis characterized by a prodromal phase of unspecific illness with fever resembling viral disease, followed by memory loss, psychiatric features, seizures, disturbed consciousness, prominent abnormal movements and autonomic imbalance. Association with ovarian teratoma is common. Neurological outcome can be good, especially when surgery is performed at an early stage. Here, we report a case of anti-NMDA receptor encephalitis associated with ovarian teratoma presenting with inaugural complex partial status epilepticus. The nature of abnormal movements at early stages was unclear and abnormal movements were misinterpreted as the recurrence of partial epileptic seizures. Despite its rarity, all clinicians treating epilepsy and movement disorders should be familiar with anti-NMDA receptor encephalitis, that appears to be a very severe but curable disease.

PMID: 19736168 [PubMed - indexed for MEDLINE]

ACUTE PSYCHOTIC MANIA: ANTI-NMDA ENCEPHALOPATHY

Med J Aust. 2009 Sep 7;191(5):284-6.
Acute psychiatric illness in a young woman: an unusual form of encephalitis.

Parratt KL, Allan M, Lewis SJ, Dalmau J, Halmagyi GM, Spies JM.
Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW. drksharp@bigpond.net.au

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.

PMID: 19740054 [PubMed - indexed for MEDLINE]

ANTI-NMDA ENCEPHALITIS

Med Mal Infect. 2009 Nov 24. [Epub ahead of print]

[Anti-NMDA-receptor encephalitis.]
[Article in French]
de Broucker T, Martinez-Almoyna L.

Service de neurologie, hôpital Delafontaine, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France.

Anti-NMDA-receptor encephalitis has been described only recently among other causes of paraneoplastic and auto-immune limbic encephalitis. Its frequency is probably underestimated. The very characteristic clinical presentation, the severity of symptoms frequently leading to the intensive care unit, the therapeutic implications of the diagnosis whatever the cause, paraneoplastic or not and, once treated, the possibility of a full recovery or mild sequels in the majority of cases justify a surveillance either in neurology wards or in infectious, psychiatric, intensive care, or pediatric units. The authors review the history of this disease, the available epidemiological data, the characteristic clinical presentation of patients, the differential diagnosis, and the suggested treatment according to an up-to-date literature review.

PMID: 19942390 [PubMed - as supplied by publisher]

PROMINENT PSYCHIATRIC SYMPTOMS IN ANTI-NMDAR ENCEPHALITIS

Eur J Clin Microbiol Infect Dis. 2009 Dec;28(12):1421-9. Epub 2009 Aug 29.

Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis.
Gable MS, Gavali S, Radner A, Tilley DH, Lee B, Dyner L, Collins A, Dengel A, Dalmau J, Glaser CA.

Department of Psychiatry, University of California San Francisco, Fresno, CA, USA. ms2gable@yahoo.com

The California Encephalitis Project (CEP), established in 1998 to explore encephalitic etiologies, has identified patients with N-methyl-D-aspartate receptor (NMDAR) antibodies, the likely etiology of their encephalitis. This study compares the presentation of such patients to those with viral encephalitis, so that infectious disease clinicians may identify individuals with this treatable disorder. Patients were physician-referred, and standardized forms were used to gather demographic, clinical, and laboratory data. Features of anti-NMDAR+ patients were compared with the viral encephalitides of enteroviral (EV), rabies, and herpes simplex-1 (HSV-1) origins. Sixteen cases with confirmed viral etiologies were all negative on NMDAR antibody testing. Ten anti-NMDAR+ patients were profiled with a median age of 18.5 years (range 11-31 years). None were Caucasian. They had a characteristic progression with prominent psychiatric symptoms, autonomic instability, significant neurologic abnormalities, and seizures. Two had a teratoma, and, of the remaining eight, four had serologic evidence of acute Mycoplasma infection. The clinical and imaging features of anti-NMDAR+ patients served to differentiate this autoimmune disorder from HSV-1, EV, and rabies. Unlike classic paraneoplastic encephalitis, anti-NMDAR encephalitis affects younger patients and is often treatable. The association of NMDAR antibodies in patients with possible Mycoplasma pneumoniae infection warrants further study.

PMID: 19718525 [PubMed - in process]