Unlocking the Puzzle Anti NMDA Receptor Encephalitis in a 4 year Old Boy

Abstract

Imaging of anti-N-methyl-D-aspartate receptor (NMDA) encephalitis is variable and non-specific, with lesions that can involve both white and grey matter depending on the underlying cause. We describe a case of anti-NMDA encephalitis in a 4-year-old male child who presented with history of unilateral focal fits, abnormal aggressive behaviour with episodes of psychosis including restlessness and self-harm (biting) for two months and abnormal movements of left hand. Imaging revealed multifocal abnormal signal areas involving right temporal lobe with other smaller enhancing foci in the right parietal subcortical white matter and right centrum semiovale. Anti-NMDA receptor antibodies were positive in CSF. The patient was treated with immunoglobulin and steroids and had a good recovery. This case highlights the imaging differentials and diagnostic challenges presenting in this age group.