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Case Reports in Neurological Medicine
Volume 2019, Article ID 2961874, 5 pages
https://doi.org/10.1155/2019/2961874
Case Report

New Onset British Accent, Acute Behavioral Changes, and Seizures: A Unique Presentation of NMDAR Encephalitis

1Department of Neurology, Inova Fairfax Hospital, Falls Church VA, USA
2Virginia Commonwealth University School of Medicine, Inova Campus, Falls Church VA, USA

Correspondence should be addressed to Mohankumar Kurukumbi; moc.liamg@113nahom

Received 19 December 2018; Revised 18 April 2019; Accepted 28 May 2019; Published 18 June 2019

Academic Editor: Peter Berlit

Copyright © 2019 Mohankumar Kurukumbi 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

The leading cause of autoimmune encephalitis is N-methyl-D-aspartate receptor (NMDAR) encephalitis. Symptoms can present as prominent behavioral abnormalities prompting inaccurate psychiatric diagnoses. Psychiatric features such as bizarre behavior, agitation, anxiety, delusions, and hallucinations are well noted in the current literature, but a manifestation of foreign accent syndrome has, to our knowledge, never been reported in cases of encephalitis. Once diagnosed, initiation of therapy can result in effective treatment. Here, we present a case of a 32-year-old female with new onset seizures and marked behavioral changes, such as speaking in a foreign accent, who was empirically treated for NMDAR encephalitis due to strong clinical suspicion, showed no improvement with first line therapy with IVIG and IV steroids, and finally had rapid resolution of symptoms with the early initiation of second line therapy of rituximab. In a young female presenting with nonspecific behavioral changes, NMDAR encephalitis should be on the differential and, although CSF antibodies are definitively diagnostic, there should be a low threshold to start empiric therapy and escalate to second line treatment.