By Shefali Hegde, MD
Eastern Virginia Medical School
Norfolk, VA
A Case of NMDA Receptor Antibody Encephalitis Responsive to Zolpidem and Lorazepam: A Proposed Diagnostic and Treatment Algorithm Management of Depression in a Patient with Brugada Syndrome: A Case Report
We had the opportunity to present a complex case at the PSV fall meeting. We proposed a novel diagnostic and treatment algorithm of a commonly misdiagnosed neuropsychiatric syndrome, anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.
Our algorithm involved treatment with zolpidem and lorazepam. We described the case of a young woman who initially presented to our emergency department with psychosis and delirium, which rapidly progressed to catatonic coma. Workup confirmed a diagnosis of anti-NMDAR encephalitis and ovarian teratoma.
The patient was treated with ovarian tumor removal and failed first-line treatments of intravenous steroids and intravenous IG (IVIG). She then had limited response to 5 sessions of plasma exchange. On day 16 of hospitalization, we opted to trial Zolpidem due to reports of its remarkable paradoxical effect in disorders of consciousness. Patient responded to Zolpidem trial with increased responsiveness to the environment, increased speech and ability to follow simple commands.
As her consciousness improved, catatonic signs became more apparent. Zolpidem was tapered and Lorazepam was trialed with continued clinical improvement at Day 30 of hospitalization. One-month following hospital discharge the patient had made a complete recovery.
This case study and review of literature highlighted that Zolpidem may be an important treatment in the acute phase of anti-NDMAR as well as to prevent neuropsychological sequelae.
