Anti-NMDA receptor encephalitis with coexisting autoimmune GFAP astrocytopathy presenting with psychiatric symptoms leading to a suicide attempt: a case report

Distinguishing altered consciousness owing to an underlying organic disorder from a psychiatric etiology can be challenging in patients presenting at the emergency department after a suicide attempt. The patient was a 52-year-old woman who jumped from the third floor of her house. She sustained a small subdural hematoma in the left cerebellar tentorium and a fracture of the right first rib. She was admitted to our tertiary emergency and critical care center for further evaluation of the head injury and remained clinically stable. On hospital day 2, the patient was diagnosed with severe depression by a psychiatrist and was transferred to a psychiatric ward. However, she developed disturbances of consciousness and cognitive impairment that could not be explained by psychiatric illness thereafter. Further workup revealed anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis and autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy as the etiology. High-dose intravenous methylprednisolone therapy together with high-dose intravenous immunoglobulin was initiated. Disturbances of consciousness and cognitive impairment did not fully recover; however, she was transferred to another hospital on day 149. Apart from psychiatric causes, organic etiologies should be considered in patients who have attempted suicide if psychiatric interventions cannot explain cognitive abnormalities. This approach facilitates timely diagnosis and management of treatable diseases such as coexisting anti-NMDAR encephalitis and autoimmune GFAP astrocytopathy.