32 days of battle for survival from deadly disease, ENCEPHALITIS

Not a very old disease, first reported in the year, 2005 NMDA-R Encephalitis.  A 15year old girl, named Priyam Wada Chettri survived this fatal disease. NMDA-R encephalitis is auto-immune disease, usually found in the young set of patients, age group most affected is 10-40 years. However the youngest age reported is two years. The common symptoms include:

·         Behavioural abnormality

·         Seizure

·         Hyper kinetic movement disorder

·         Autonomic  dysfunction

·         Altered sensorium

These symptoms are often confused with typical virus encephalitis. Diagnosis is aided by MRI Brain, NMDA-R receptor-antibody in serum & CSF along with other ancillary tests but high index of suspicion is utmost important because this is a very rare disease. treatment is mainly IVIG and other supportive care. Outcome is reasonably good however recovery may take several months. Priyam has recovered in a month; this is an incredible remark to the doctor whose professional expertise has proved its outcome.

Ms. Priyam Chettri  presented with a two weeks history of disturbed sleep, behavioural abnormality, 3 episodes of GTCS (geaneralized tonic clonic seizure) (spread over 4 days) followed by altered sensorium.  No history of headache, fever or vomiting was there. Her GCS (Glasgow Coma Scale) was futher worsening for which she was intubated and put on mechanical ventilation. Several tests were taken, MRI brain report showed – signal changes in bilateral cingulate gyri posterior occipito-temporal lobes and right parahippocampal gyrus.   MRI Spine screening was within normal limits, Dengue serology, malaria antigen and typhi dot tests were negative. Based on clinico-historical-radiological-pathological observation a tentative diagnosis of encephalitis syndrome was made and treatment was initiated on that line with proper antibiotics, antiviral, antipyretic, antiepileptic and other supportive care. Doctor noticed various types of abnormal involuntary movements like facial dyskinesia, multiple choreiform movements. She also developed marked autonomic dysfunction, so a possibility of autoimmune encephalitis was thought of and NMDA-R ab and anti VGKC-ab were sent.  Even though the test results were not revealed but on the patients deteriorating condition doctor had already proceeded with the treatment.  When the treatment was half its way the results were despatched and NMDA-R ab came positive.  The strong technical and professional experience of the doctor that helped him diagnose and start with early treatment even before the test reports had only helped that the patient revived from the ailment and was given right medication at the right time.

“It’s like a rebirth for my daughter. I am 101 percent satisfied. I am short of words to express my gratitude and thankfulness for the entire team who gave my daughter a second life“, expressed mother of Priyam , Yasoda Chettri.

“ Neurologists should start doubting such cases where typical presentation of viral Encephalitis is not present,at the very early stage and its accompanied by the various symptoms described above, especially abnormal involuntary movements. so that treatment can be started before the condition deteriorates, especially in the younger set of patients, higher index of suspicion should be maintained”, stated by Dr. Swayam Prakash, Consultant Neurologist at Neotia Getwel Health care Centre.