Anti-NMDA-Receptor Encephalitis: Clinical Case Study and Implications for Nurse Practitioners

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a treatable autoimmune encephalitis that often presents with acute behavioral change or psychosis and rapidly evolves to dysautonomia, movement disorder, seizures, and decreased level of consciousness. We report a 26-year-old woman who presented to an Emergency Department (ED) with first-episode psychosis, autonomic instability, and orofacial dyskinesias. After an initial medical evaluation, the patient was referred to the ED Psychiatric Nurse Practitioner (NP), whose prompt application of a structured autoimmune-encephalitis diagnostic approach enabled expedited neurology consultation, cerebrospinal fluid (CSF) confirmation of anti-GluN1 antibodies, and early immunotherapy (steroids, plasma exchange, rituximab). At the three-month follow-up, she had resumed full-time work without psychotropic medication. This case underscores the value of structured diagnostic reasoning and early referral pathways in the emergency department.