• Yu-Ming Chen and Pei-Hsin Kuo.
• Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
• Medicine (Baltimore). 2020 Feb 1; 99 (9): e19384.

RationaleAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease that is associated with cell-surface NMDAR-targeting autoantibodies. Typical anti-NMDAR encephalitis symptoms include psychosis, seizure and extrapyramidal side effects. However, early diagnosis of anti-NMDAR encephalitis remains challenging due to the complexity of the motor phenomenon.Patient ConcernsHere, we report a new diagnosis of anti-NMDAR encephalitis in a young woman with a history of epilepsy.DiagnosesElectroencephalography revealed a typical "extreme delta brush" pattern, which indicated anti-NMDAR encephalitis.InterventionsThe clinical status of the patient markedly improved after immediate and aggressive immunosuppression therapies.OutcomesThe patient was discharged with mild cognitive impairment. However, this was completely resolved 1 month postdischarge.LessonsWe conclude that subacute onset focal seizure with psychosis as well as compatible electroencephalography findings (i.e., extreme delta brush patterns) should be considered notable early indicators of anti-NMDAR encephalitis. This would ensure early and effective clinical interventions, which are essential for favorable outcomes.

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