Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8648-8655
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8648
Paroxysmal speech disorder as the initial symptom in a young adult with anti-N-methyl-D-aspartate receptor encephalitis: A case report
Chuan-Chen Hu, Xiao-Ling Pan, Mei-Xia Zhang, Hong-Fang Chen
Chuan-Chen Hu, Xiao-Ling Pan, Mei-Xia Zhang, Hong-Fang Chen, Department of Neurology, The Affiliated Jinhua Hospital, School of Medicine, Zhejiang University, Jinhua 321000, Zhejiang Province, China
Author contributions: Hu CC wrote the manuscript; Zhang MX was responsible for data acquisition; Pan XL revised the manuscript; Chen HF followed the patient during treatment and contributed to the conception of the paper; and all authors granted final approval for the version to be submitted.
Informed consent statement: Informed consent was obtained verbally from the patient for publication of this report.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Fang Chen, MM, Adjunct Professor, Chief Physician, Director, Department of Neurology, The Affiliated Jinhua Hospital, School of Medicine, Zhejiang University, No. 365 Renmin East Road, Jinhua 321000, Zhejiang Province, China. chenhongfang@zju.edu.cn
Received: January 19, 2022
Peer-review started: January 19, 2022
First decision: April 8, 2022
Revised: April 22, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 26, 2022
Processing time: 208 Days and 10.1 Hours
Abstract
BACKGROUND

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable but frequently misdiagnosed autoimmune disease. Speech dysfunction, as one of the common manifestations of anti-NMDAR encephalitis, is usually reported as a symptom secondary to psychiatric symptoms or seizures rather than the initial symptom in a paroxysmal form. We report a case of anti-NMDAR encephalitis with paroxysmal speech disorder as a rare initial manifestation, and hope that it will contribute to the literature.

CASE SUMMARY

A 39-year-old man with anti-NMDAR encephalitis initially presented with paroxysmal nonfluent aphasia and was misdiagnosed with a transient ischemic attack and cerebral infarction successively. The patient subsequently presented with seizures, but no abnormalities were found on brain magnetic resonance imaging or electroencephalogram. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis and increased protein levels. Anti-NMDAR antibodies in serum and CSF were detected for a conclusive diagnosis. After immunotherapy, the patient made a full recovery.

CONCLUSION

This case suggests that paroxysmal speech disorder may be the presenting symptom of anti-NMDAR encephalitis in a young patient.

Keywords: Anti-N-methyl-D-aspartate receptor encephalitis; Autoimmune disease; Paroxysmal speech disorder; Seizure; Immunotherapy; Case report

Core Tip: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable but often misdiagnosed autoimmune disease. In this paper, we describe a 39-year-old man with anti-NMDAR encephalitis who initially presented with paroxysmal speech disorder and was subsequently misdiagnosed with a transient ischemic attack and cerebral infarction. The definitive diagnosis was made based on the detection of anti-NMDAR antibodies in serum and cerebrospinal fluid. The patient recovered completely after immunotherapy. This case suggests that paroxysmal speech disorder may be the first symptom of anti-NMDAR encephalitis in a young patient without risk factors for cerebrovascular disease.