Anti-NMDA Receptor Encephalitis

Anti-NMDA receptor encephalitis can begin with insomnia, paranoia, hallucinations, or abrupt behavioral change, then declare itself through seizures, abnormal facial or limb movements, impaired consciousness, and unstable autonomic or respiratory function. That change in pattern is the bedside clue: a new psychiatric syndrome that acquires objective neurologic signs should be investigated as encephalitis, not managed as an isolated psychiatric disorder. The antibody targets GluN1-containing NMDA receptors and reduces their surface availability, disrupting circuits for cognition, behavior, movement, and autonomic control. Because MRI may be unrevealing and serum antibody testing can be negative, a reassuring scan or negative blood result does not close the case. Use Graus clinical criteria and supportive CSF or EEG findings while sending CSF NMDAR IgG; CSF positivity confirms definite disease. Begin first-line immunotherapy when suspicion is high rather than waiting for a reference-laboratory result, and search for an ovarian teratoma in all female patients. The immediate nursing priority is to detect the transition from behavioral disturbance to airway compromise, status epilepticus, hyperthermia, severe dyskinesia, or autonomic instability.