Anti-N-methyl-d-aspartate Receptor Encephalitis Related Sinus Node Dysfunction and the Lock-Step Phenomenon

Area of Science:

• Neurology
• Immunology
• Cardiology

Background:

• Anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE) is a rare autoimmune limbic encephalitis.
• It predominantly affects young women and can be a paraneoplastic manifestation of ovarian teratoma.
• ANMDARE presents with psychiatric and neurological changes, autonomic instability, and cardiac dysrhythmias.

Purpose of the Study:

• To present a case of ANMDARE in a pregnant patient.
• To highlight the cardiac manifestations and pathophysiology of autonomic instability in ANMDARE.
• To discuss management strategies for this rare illness.

Main Methods:

• Case report of a 36-year-old pregnant woman.
• Clinical presentation including confusion and seizures.
• Electroencephalography (EEG) demonstrating the extreme delta brush pattern.
• Cardiac evaluation revealing sinus nodal dysfunction.
• Diagnosis of ovarian teratoma.

Main Results:

• The patient presented with confusion, seizures, and an EEG pattern consistent with ANMDARE.
• Cardiac involvement was evidenced by sinus nodal dysfunction.
• An ovarian teratoma was identified, consistent with ANMDARE as a paraneoplastic syndrome.
• The case underscores the typical presentation of ANMDARE in relation to ovarian teratoma.

Conclusions:

• ANMDARE is a significant autoimmune encephalitis with diverse manifestations, including cardiac issues.
• Ovarian teratoma is a common underlying cause, particularly in women of reproductive age.
• Early recognition and management are crucial for improving outcomes in ANMDARE.