"Paul never returned for his appointment that week. He suffered a seizure in the night and an ambulance took him to the emergency department. After a long barra

"Paul never returned for his appointment that week. He suffered a seizure in the night and an ambulance took him to the emergency department. After a long barrage of sedation, testing and imaging, he was eventually seen by the neurologist, who made the diagnosis. The answer was hiding in Paul’s cerebrospinal fluid – a rare condition first described in 2007. Anti-NMDA receptor encephalitis is an autoimmune process, in which antibodies against the NMDA (N-methyl-D-aspartate) receptors are produced. About 80% of female patients with the condition have an ovarian teratoma that is thought to be the site of the extra-cerebral tissue that triggers the immune system to attack the brain. The inflammation occurs in the limbic system, particularly the mesolimbus, hippocampus and dorsolateral prefrontal cortex. The autonomic system is involved later in the disease, resulting in unstable cardiovascular and respiratory function. While lesser known, anti-NMDA encephalitis is more common than viral encephalitis in young people"