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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal autoimmune disorder characterized by the production of antibodies against NMDAR. This condition leads to significant dysregulation of neurotransmission, resulting in a wide range of neuropsychiatric symptoms, including seizures, hallucinations, abnormal movements, and autonomic disturbances. Due to its diverse presenting manifestations, anti-NMDAR encephalitis is often underdiagnosed and can be misdiagnosed as viral or other types of encephalitis. Therefore, when clinical suspicion arises, testing for anti-NMDA receptor antibodies in cerebrospinal fluid or serum is crucial for an accurate diagnosis. Here, we report the case of a 15-year-old girl who initially presented with psychiatric symptoms and progressive mental changes, and was diagnosed with anti-NMDAR encephalitis. During the evaluation for paraneoplastic syndrome, a mature ovarian teratoma was discovered, and tumor resection was subsequently performed. She was treated sequentially with methylprednisolone, intravenous immunoglobulin, plasmapheresis, and rituximab. However, her altered mentality and intractable dyskinesia persisted. These symptoms were ultimately successfully managed with a combination of diazepam, dantrolene sodium hydrate, and olanzapine. An accurate early diagnosis and prompt intervention are crucial for improving the clinical outcomes of patients with anti-NMDAR receptor encephalitis. Dyskinesia is often present and can be quite intractable, indicating a need for evidence-based management guidelines. Key Words: Encephalitis; Pediatrics; Critical illness
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