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Eur J Paediatr Neurol. 2014 Jan;18(1):72-4. doi: 10.1016/j.ejpn.2013.07.002. Epub 2013 Aug 15.

Anti-NMDAR encephalitis misdiagnosed as Hashimoto's encephalopathy.

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Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy. Electronic address:
Neuroscience Department, Istituto Giannina Gaslini, Genoa, Italy.
Paediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.
Paediatric Unit, San Paolo Hospital, Savona, Italy.
Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.


Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a well-defined autoimmune disorder. Hashimoto's encephalopathy (HE) is a still controversial entity, lacking definite diagnostic criteria. We described a 14-year-old-girl presenting with a clinical picture consistent with the diagnosis of anti-NMDAR encephalitis, confirmed by NMDAR antibody testing. Four years earlier, she had presented a similar episode of acute encephalopathy diagnosed as HE. Anti-NMDAR encephalitis and HE share similar clinical features so that the differential diagnosis can be difficult if specific antibodies are not tested. The correct diagnosis of anti-NMDAR encephalitis is crucial to plan the appropriate management and follow-up, namely in term of oncological screening, since it can be paraneoplastic in origin. We suggest to re-evaluate the clinical history of all subjects with previous HE diagnosis in order to evaluate the possible diagnosis of anti-NMDAR encephalitis and plan the appropriate management of these patients.


Anti-N-methyl-D-aspartate receptor encephalitis; Epilepsy; Hashimoto encephalopathy; Neuronal surface antibodies; Paraneoplastic

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