A Rare Case of Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Status Epilepticus in Pregnancy

Author(s): Meryl M Sperling, Anne Waldrop, Cedar Fowler, Julianna J Weiel, Charlotte L Conturie, Katherine Bianco

Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder that can lead to psychosis and severe neurological symptoms and is extremely rare in pregnancy. It is often associated with an ovarian teratoma, with many having symptomatic improvement after its removal. Many patients have a prolonged recovery time to their baseline neurological status.

Case: This is a 33 year old G4P2012 who presented at 14 weeks gestation in status epilepticus after a 1 week history of acute behavioral changes, who was found to have an ovarian teratoma with anti-NMDA receptor encephalitis. She remained hospitalized throughout the duration of her pregnancy, which was complicated by drug induced hepatotoxicity, severe short term memory loss, tracheostomy and percutaneous gastric tube placement. The fetus was in breech presentation at 39 weeks, at which time an external cephalic version (ECV) was attempted and was unsuccessful, leading to an emergent primary cesarean delivery without complications.

Conclusion: Anti-NDMA receptor encephalitis is a rare event that can occur in pregnancy that can lead to debilitating neurological symptoms. Due to the complexity of these patients, optimal care should be focused around a multidisciplinary team in order to optimize maternal care. We did not find a need to deliver the patient preterm and followed standard obstetric management in guiding decision-making around her pregnancy.