Sat, Apr 20, 2019 - Page 2 News List

Woman gets autoimmune brain disorder diagnosis

By Tsai Shu-yuan and Jake Chung  /  Staff reporter, with staff writer

Asia University Hospital chief neurologist Wang Hsin-fan points to the location of a disease known as anti-NMDA receptor encephalitis on a brain model in the hospital’s consulting room in Taichung on Thursday.

Photo: Chen Chien-chih, Taipei Times

A woman who displayed symptoms of irritation and paranoia has been diagnosed with anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis, a type of neurological autoimmune disease, a doctor said on Thursday.

Physicians at Asia University Hospital had to sedate a 35-year-old woman surnamed Tsai (蔡) before admitting her, as she was thrashing around, neurologist Wang Hsin-fan (王馨範) said.

After conducting tests, doctors found that Tsai had more than the regular amount of white blood cells and protein, but a slight decrease in blood sugar and blood flow to the brain, Wang said.

While in the hospital, Tsai experienced epileptic attacks, respiratory depression, an irregular heart rate (cardiac dysrhythmia), elevated levels of carbon dioxide in the bloodstream (hypercapnia), dystonia, fluctuation of blood pressure, unconsciousness and fever, he added.

Tsai at one point had to be placed on breathing support and was initially given antibacterials and steroids, Wang said.

After a cerebrospinal fluid analysis, doctors suspected that Tsai had meningitis, Wang said, adding that it was only after a lab analysis for anti-glutamate receptor antibodies that doctors determined she had anti-NMDA receptor encephalitis.

Tsai then underwent plasmapheresis, which removes harmful antibodies from the blood through a process similar to dialysis, restoring consciousness to Tsai and normalizing her blood pressure and heartbeat, Wang said.

After treatment, Tsai was able to take care of her basic needs, although she still became easily angered before her discharge from the hospital, Wang said.

Initial symptoms for anti-MNDA receptor encephalitis are similar to that for meningitis and can only be differentiated after a cerebrospinal fluid analysis for the antibodies is conducted, Wang said.

About 40 percent of people with the condition develop tumors, while others exhibit immune system abnormalities, Wang said, adding that they should undergo extensive immunotherapy and take additional tests for potential tumors.

Delayed treatment could lead to sequela, which could be fatal if severe enough, he said.

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