Dynamics of psychopathological manifestations in anti-NMDAR encephalitis: a case report

Anti-NMDAR encephalitis is a rare but clinically significant condition that mainly affects children, adolescents, and young adults. Although its acute presentation, including psychotic symptoms, motor disturbances, epileptic seizures, and autonomic dysfunction, is well characterized, long-term cognitive, emotional, and social outcomes remain poorly understood. In Russian research, most reports are limited to the acute phase, and extended follow-up studies are scarce. This case report addresses this gap by illustrating the disease dynamics and its consequences over several years. We describe a female patient born in 2001 whose disease began in 2019 with psychotic symptoms and severe neurological deficits. The diagnosis of anti-NMDAR encephalitis was confirmed by clinical, laboratory, and neuroimaging findings. MRI showed multiple lesions in the basal ganglia and temporal lobes; laboratory tests revealed signs of reactive hepatitis and endocrine dysfunction; and serum testing detected NMDA receptor antibodies. Treatment included methylprednisolone pulse therapy, symptomatic management, and rehabilitation, leading to gradual improvement. However, the patient later required repeated hospitalizations for organic psychiatric disorder, with episodes of cognitive decline and emotional instability. Over nearly three years, she had persistent cognitive and emotional-volitional impairments, social limitations, and required continuous follow-up with neurologists and psychiatrists. This case shows that anti-NMDAR encephalitis can result in severe acute manifestations and significant long-term consequences that affect quality of life. It underscores the importance of a multidisciplinary approach—involving neurologists, psychiatrists, rehabilitation specialists, and allied professionals—and the need for systematic study of long-term outcomes. Thus, this report helps fill the gap in knowledge on the long-term course of anti-NMDAR encephalitis and highlights the need for further data collection.

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