Altered perception might be a symptom of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis

ABSTRACT

Most patients with N-methyl-D-aspartate receptor (NMDAR) encephalitis initially present with psychiatric symptoms. Although a delayed diagnosis may lead to a poor outcome, psychiatric symptoms that could differentiate anti-NMDAR encephalitis from other psychoses have not been fully investigated. We evaluated two patients with anti-NMDAR encephalitis who were observed by psychiatrists from onset throughout the course of disease. Both patients exhibited disorientation, memory deficits, perceptual disturbances, hallucinations, and mood liability. Among those, altered perceptions were most prominent - in particular, altered time perceptions without disorganization syndrome. The information obtained for these patients may help clinicians differentiate anti-NMDAR encephalitis from other psychoses, e.g., schizophrenia.

KEYWORDS:

• Anti-NMDAR encephalitis
• altered time perceptions
• Alice in Wonderland syndrome
• schizophrenia

Acknowledgments

The authors express their sincere thanks to the patients and their family members.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

MF acquired case data, designed the study, and drafted the manuscript. JM, TT, and AK acquired case data. MM supervised the study. All authors read and approved the final manuscript.

Consent

This study was performed after obtaining written, informed consent from each of the patients and their family members. Likewise, informed consent was also obtained for publication of this case report and accompanying images. Ethical aspects of this study were reviewed and approved by the Ashikaga Red Cross Hospital Human Research Ethics Committee.