We present a case of a 65 years old man from Islamabad who presented with six months history of psychiatric and behavioural symptoms, significant weight loss. Later on he developed difficulty swallowing and altered sensorium. This was followed by an episode of shortness of breath leading to respiratory arrest, followed by ICU stay on ventilator support, then developed focal deficit in form of left sided weakness, dysautonomia, bradycardia leading to cardiac arrest and another cardiopulmonary resuscitation, myoclonic jerks, orofacial dyskinesias, status epilepticus, coma ultimately resulting in death of the patient. Patient was found to be NMDA receptor antibody positive. CT chest and abdomen did not reveal any hidden malignancy. Patient was given intravenous pulse steroids for 5 days followed by five sessions of plasmapheresis but did not respond. He stayed on ventilator support for 40 days and did not improve. This is the second case of antibody proven NMDA encephalitis from Pakistan, the first being from Islamabad as well and published in this journal.
Niazi, Farheen; Hameed, Abdul; Hussain, Tariq; Faiz, Sarah; and Atique, Hassan
"NMDA encephalitis in an elderly with poor prognosis,"
Pakistan Journal of Neurological Sciences (PJNS): Vol. 11
, Article 10.
Available at: http://ecommons.aku.edu/pjns/vol11/iss4/10