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Case Report
Suspicion index: Psychiatric manifestations of NMDAR encephalitis in paediatric patients
Índice de sospecha: manifestaciones psiquiátricas de la encefalitis por anticuerpos anti-NMDAR en pacientes pediátricos
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Juan Fernando Gómez Castroa,
Corresponding author
jfgomezcastro@gmail.com

Corresponding author.
, Omar Salazarb, Zenayda Condeb
a Departamento Materno-Infantil, Fundacion Valle del Lili, Universidad ICESI, Cali, Colombia
b Departamento de Psiquiatría, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia
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Abstract

Immune encephalitis is a diverse group of disorders that share some unique diagnostic approaches and specific treatments. Some of the initial manifestations are non-specific and difficult to distinguish from encephalitis of other aetiologies, and even with modern diagnostic tools there are still a number of cases for which definitive causes cannot be clarified. Among these, N-methyl-d-aspartate receptor (NMDAR) encephalitis is a particular form of immune encephalitis that has some distinctive clinical manifestations, which allows the clinical evaluator to suggest a more accurate diagnosis and start treatments even in the absence of specific laboratory tests. Three paediatric patients, who were treated for NMDAR encephalitis are described in this article, as well as comparing their clinical presentation. This specific disorder and some of the more relevant features of its physiopathology are reviewed in order to explain the initial psychiatric manifestations, for which early recognition is critical for an appropriate diagnosis and treatment.

Keywords:
Encephalitis
Psychiatric manifestations
NMDAR
Resumen

Las encefalitis inmunitarias son un grupo particular de trastornos que se distinguen por su aproximación diagnostica única y manejo específico. Algunas de las manifestaciones iniciales son inespecíficas y difíciles de distinguir de encefalitis de otros orígenes, e incluso con los tests diagnósticos modernos aún hay cierto número de casos en que no se logra aclarar la causa específica. Entre ellas, las encefalitis anti-NMDAR son una particular forma de encefalitis inmunitaria que tiene manifestaciones clínicas distintivas, algunas de las cuales permiten al evaluador médico apuntar a un diagnóstico más preciso e iniciar tratamientos aun sin tener los reportes específicos de laboratorio. En este artículo se presentan 3 casos de pacientes pediátricos tratados como encefalitis anti-NMDAR, y después de comparar su presentación clínica, se revisa este trastorno específico y algunos de los datos más relevantes en su fisiopatología, como una forma de explicar las manifestaciones psiquiátricas iniciales, de cuyo reconocimiento inicial van a depender los apropiados diagnóstico y tratamiento.

Palabras clave:
Encefalitis
Manifestaciones psiquiátricas
Receptor NMDAr

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