• François-Xavier Lapébie, Céline Kennel, Laurent Magy, Fabrice Projetti, Jérôme Honnorat, Nicolas Pichon, Philippe Vignon, and Bruno François.
• Intensive Care Unit, University Hospital Dupuytren, Limoges, France. b.francois@unilim.fr.
• BMC Anesthesiol. 2014 Jan 16; 14: 5.

BackgroundMany anesthetic drugs interact with the NMDA receptor and may therefore alter the clinical presentation of anti-NMDA-R encephalitis.Case PresentationA 24-year-old woman was admitted to hospital for decreased consciousness and hyperthermia. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, and elevated protein. Cultures were negative. Patient state worsened with agitation, facial dyskinesia, ocular deviation, and limb dystonia. Diagnosis of anti-NMDA-R encephalitis was evidenced by specific antibodies. High doses of methylprednisolone were administered. CT scan disclosed an ovarian teratoma and tumor resection was scheduled under anesthesia with propofol, sufentanil, atracurium and sevoflurane. Sedation after surgery was maintained with propofol. Rapidly after surgery, patient's condition deteriorated with increase of dyskinesias, and two tonic-clonic generalized seizure events.ConclusionIn patients with anti-NMDA-R encephalitis, anesthesia using benzodiazepines, opiates and curares, which fail to interfere with the NMDA pathway, should be preferred.

24 keywords...

hide…