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Optic Nerve Atrophy in N-methyl-D-aspartate (NMDA) Encephalitis
David C Schulz1, Sachin K Pandey2, Lulu L C D Bursztyn1,3
1Department of Ophthalmology, Western University, London, Canada.
Abstract:
N-methyl-D-aspartate receptor (NMDA) encephalitis is a recently described autoimmune disease that typically presents with prodromal symptoms including upper respiratory tract infection, headache, fever, nausea, vomiting and diarrhea. Psychiatric symptoms follow within weeks, including anxiety, insomnia, mania, paranoia and grandiose delusions. The diagnosis is confirmed by the detection of NMDA antibodies in the serum or cerebrospinal fluid (CSF).1 Tumours, especially teratomas, are frequently associated with NMDA encephalitis; however, only 5% of male patients older than 18 years have been found to have an underlying tumour. Optic neuropathy associated with NMDA encephalitis is being increasingly recognised in the literature2-6 and was reviewed most recently by Mugavin et al.2 in 2017. In this report, we present a case of bilateral optic neuropathy in a young man diagnosed with NMDA receptor encephalitis.
Insights
N-methyl-D-aspartate receptor (NMDA) encephalitis can cause vision loss. This case report highlights bilateral optic neuropathy in a young man with NMDA receptor encephalitis, emphasizing the importance of recognizing this neurological complication.
Area of Science:
- Neurology
- Immunology
- Ophthalmology
Background:
- N-methyl-D-aspartate receptor (NMDA) encephalitis is an autoimmune disorder.
- It often presents with psychiatric and neurological symptoms.
- Tumors, particularly teratomas, are associated with NMDA encephalitis.
Observation:
- Optic neuropathy is an increasingly recognized complication of NMDA encephalitis.
- This report details a case of bilateral optic neuropathy in a young male patient.
- The patient was diagnosed with NMDA receptor encephalitis.
Findings:
- The diagnosis of NMDA encephalitis was confirmed by detecting NMDA antibodies.
- The patient presented with bilateral optic neuropathy.
- This case adds to the literature on visual disturbances in NMDA encephalitis.
Implications:
- Ophthalmologists and neurologists should consider NMDA encephalitis in patients with unexplained optic neuropathy.
- Early diagnosis and treatment of NMDA encephalitis may improve visual outcomes.
- Further research is needed to understand the mechanisms of optic nerve involvement in autoimmune encephalitis.
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