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Encephalitis (Clinical
presentation (NMDA (Psychiatric symptoms
…
Encephalitis
Clinical
presentation
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NMDA
Psychiatric symptoms
(agitation, anxiety, delusions, paranoia,
visual/auditory hallucinations, catatonia)
Movement disorder
(orofacial dyskinesia, choreoathetosis, dystonia)
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-
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Aetiology
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Infection
Viral - HSV1*, HSV2, enterovirus
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Diagnosis
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Investigations
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Bloods
FBC, CRP, U+E, LFTs
Blood cultures
Autoantibodies: VGKC, NMDA
Imaging
CT/MRI head
Oedema, mass effect, high signal in mesial temporal regions;
also signal in other structures (if NMDA/VGKC)
CT/MRI chest/abdo/pelvis
Tumour search if suspected (teratoma, SCLC)
LP
CSF for WCC, protein, glucose, PCR (HSV)
Autoantibodies: VGKC, NMDA
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History
Infection, other
autoimmunity
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Management
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Definitive
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NMDA encephalitis
Corticosteroids
IV Ig, plasma exchange
Tumour resection
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