Poster 13: Management of Anti-NMDA Receptor Encephalitis in the Rehabilitation Setting: A Case Report

Article Outline

• Disclosures
• Patients or Programs
• Program Description
• Setting
• Results
• Discussion
• Conclusions
• Copyright

Keywords: Inpatient rehabilitation, NMDA receptor antibodies, Paraneoplastic encephalitis, Ovarian teratoma

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Disclosures 

W. J. Kroski, None.

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Patients or Programs 

An 18-year-old female with anti-NMDA receptor encephalitis.

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Program Description 

The patient presented with headache, fevers, myalgias, and seizure-like activity that began 1 week prior to admission. Her condition deteriorated over the next week with episodes of aggressive agitation and worsening mental status requiring intubation to protect her airway. At this time she was not responding to commands, eyes remained closed, and she had nearly continuous involuntary oromandibular and lower extremity movements. She had a prolonged ICU stay and required hospitalization in an acute care hospital for 3 months after which she was transferred to an acute inpatient rehabilitation hospital. During inpatient rehabilitation, the therapies provided were similar to those provided to a patient with traumatic brain injury. However, there were differences in the medical and behavioral management of this patient.

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Setting 

Inpatient rehabilitation facility.

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Results 

Upon admission to the rehabilitation facility, she was maximal assistance to dependent in all functional activities with profoundly impaired arousal and attention. Her response to rehabilitation was excellent. At the time of discharge, she was independent with mobility and required supervision for daily living skills due to ongoing cognitive impairment.

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Discussion 

This case represents a diagnosis which is rarely seen in the rehabilitation setting. The treatment of patients with anti-NMDA receptor encephalitis in the acute inpatient rehabilitation setting has not been reported in the literature previously.

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Conclusions 

For many patients with this diagnosis, the functional, cognitive and behavioral impairment, and prolonged recovery would make the inpatient rehabilitation setting the most appropriate level of care. This case exemplifies the management of this population in the inpatient rehabilitation setting, in particular the response to a typical brain injury rehabilitation program.