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Case Reports in Critical Care
Volume 2013 (2013), Article ID 383125, 2 pages
http://dx.doi.org/10.1155/2013/383125
Case Report

Ketamine Infusion Associated with Improved Neurology in a Patient with NMDA Receptor Encephalitis

1Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
2University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, UK

Received 12 June 2013; Accepted 22 July 2013

Academic Editors: C. Diez, M. Egi, C. Mammina, A. J. Reddy, and K. S. Waxman

Copyright © 2013 Michael MacMahon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A young lady was ventilated on intensive care for a prolonged period with NMDA receptor encephalitis. She had undergone steroid, immunoglobulin, and plasmapheresis with no evidence of recovery. Her main management issue was the control of severe orofacial and limb dyskinesia. Large doses of sedating agents had been used to control the dystonia but were ineffective, unless she was fully anaesthetised. The introduction of a ketamine infusion was associated with a dramatic improvement in her symptoms such that it was possible to remove her tracheostomy two days after commencement. She was discharged shortly after that and is making a good recovery. The successful use of ketamine has not previously been described in this context, and we hope this case report will provide some insight into the management of this rare but serious condition.