Toddler's Gait Disturbance Could Signal Encephalitis

Diagnosing Anti-N-methyl D-aspartate receptor (NMDAR) antibody encephalitis in adults differs from doing so in young children. Gait disturbance is a reliable sign, a Johns Hopkins team reports.

Anti-N-methyl D-aspartate receptor (NMDAR) antibody encephalitis is a potentially lethal condition. In children under 3 symptoms differ from those in adults, a Baltimore, MD research team is due to report in a poster session April 19 at the American Academy of Neurology meeting in Washington, DC.

While adults tend to have personality changes progressing to seizures, dyskinesias and autonomic instability children do not. They typically have disrupted speech and sleep patterns and later develop motor dysfunction, dyskinesias, and seizures. But since the symptoms are initially vague, diagnosis of anti-NMDAR encephalitis is often delayed.

In an abstract, Anusha Yeshokumar, MD and colleagues at Johns Hopkins Medicine report on 4 patients, all under age 3, diagnosed with the condition. One had unsteady walking and slurred speech, 3 were unable to put any weight on a lower extremity and of those 3, two also had seizures.

All patients developed the classic signs of anti-NMDAR encephalitis and cerebrospinal studies showed positive anti-NMDAR antibodies.

CSF studies showed pleocytosis in 2 patients who also had seizures. MRI brain studies in 2 patients showed subtle multifocal cortical T2 FLAIR hyperintensities. Two patients had normal imaging. Two patients had normal electroencephalograms.

The team’s conclusion was that in treating children under age 3 with a gait disturbance, a manifestation of cerebellar ataxia or cortical motor dysfunction, physicians should be concerned these patients may have anti-NMDAR encephalitis.