Abstract Introduction Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune neuropsychiatric disorder that may present with psychiatric symptoms, seizures, and respiratory failure requiring critical care. We describe a young woman whose recurrent seizures and behavioral changes led to the diagnosis of NMDA receptor antibody-positive autoimmune encephalitis, emphasizing early recognition and multidisciplinary management. Case Presentation A 25-year-old woman with childhood febrile seizure, asthma, and chronic anxiety/depression with prior psychotic episodes experienced relapse of severe depression after stopping psychiatric medication during pregnancy. Months later, she developed a new-onset generalized tonic-clonic seizure, followed by additional episodes and post-ictal agitation. EEG was initially nondiagnostic. Levetiracetam was started, but recurrent seizures required dose escalation and benzodiazepines. Behavioral agitation prompted antiseizure regimen modification and addition of valproate and psychotropic medications. Despite these adjustments, she developed status epilepticus and encephalopathy requiring intubation for airway protection. Continuous EEG revealed right-temporal and bifrontal epileptiform discharges with diffuse slowing. Cerebrospinal fluid was unremarkable, but autoimmune encephalopathy testing confirmed NMDA receptor antibodies. High-dose intravenous methylprednisolone (1 g daily for six doses) followed by intravenous immunoglobulin (0.4 g/kg/day for five days) led to gradual improvement. After extubation, she remained bradyphrenic and bradykinetic but non-agitated. Given the strong association between NMDA receptor encephalitis and ovarian teratoma, pelvic MRI was obtained and revealed a left ovarian dermoid cyst (Figure 1); she previously had right salpingo-oophorectomy and left cystectomy for dermoid cysts. Gynecology, neurology, and psychiatry collaborated to continue immunotherapy and defer surgical intervention while monitoring for recovery. Limited access to plasmapheresis necessitated completion of IVIG therapy and initiation of an oral prednisone taper. Follow-up EEG showed improvement in background activity. Discussion This case highlights the diagnostic complexity of autoimmune encephalitis in patients with overlapping psychiatric illness and new-onset seizures. In the ICU, persistent encephalopathy after seizure control should prompt evaluation for autoimmune causes. Early initiation of immunotherapy—corticosteroids, IVIG, or plasmapheresis—and tumor screening are central to management. Multidisciplinary coordination between critical care, neurology, psychiatry, and gynecology optimizes outcomes. Conclusion NMDA receptor antibody-positive autoimmune encephalitis is a reversible cause of status epilepticus and neuropsychiatric decline in young women. Prompt recognition and immunotherapy are essential to achieving neurological recovery. This abstract is funded by: N/A
Abdullah et al. (Fri,) studied this question.