Anti-NMDA Receptor Encephalitis presenting with severe episodic hypertension: a case report

Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is one of the most commonly emerging autoimmune encephalitis in children and young adults in recent years. Clinical manifestations range from prodromal symptoms to seizures, movement disorder, psychiatric manifestations, cognitive/speech impairment, and autonomic dysfunction. Our case presented with initial symptoms of severe episodic hypertension, sweating, agitation, and tachycardia. She received early care for pheochromocytoma and panic disorder in Qatar, but there was no relief. Three weeks later, she presented in our emergency room with seizures, cognitive/speech impairment, and orofacial dyskinesia. Electroencephalography EEG revealed right hemispheric delta activity and cerebrospinal fluid CSF anti-NMDA Receptor IgG was positive. Magnetic resonance imaging MRI brain and CSF studies were normal. She was treated symptomatically for hypertension and psychiatric manifestations. She received high dosage pulse intravenous methylprednisolone, followed by intravenous immunoglobulin, which significantly alleviated her cognitive, neuropsychiatric, and autonomic features. Severe Hypertension is an uncommon presentation of Anti- NMDAR encephalitis.  Early recognition and prompt management improves prognosis and long term sequelae.