Recurrent Asystole Without Generalized Dysautonomia in Anti‐ <scp>NMDA</scp> Receptor Encephalitis: A Case Report

ABSTRACT Background Life‐threatening arrhythmias in anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis are typically regarded as part of a generalized autonomic storm. However, severe bradyarrhythmia occurring as the primary life‐threatening feature in the absence of a generalized autonomic storm is rare. Case Presentation A 27‐year‐old woman presented with a 2‐week history of neuropsychiatric symptoms. She was diagnosed with anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis, supported by a positive cerebrospinal fluid (CSF) antibody test and an ovarian teratoma. Her hospital course was complicated by recurrent asystolic cardiac arrests, which occurred as the most critical feature of her autonomic instability and required temporary pacing. The patient recovered fully after immunotherapy and tumor resection. Conclusions This report identifies a critical diagnostic pitfall and highlights the necessity of continuous cardiac monitoring during the acute phase, even in patients who appear autonomically stable.