Coronal section of rat brain showing NMDA-R intense reactivity predominantly involving the hippocampus.
(From Dalmau, et al. 2008. Lancet)

Thanks to Thomas Vu and Dr. Mathisen for a great morning report!

Learning points:
– Peripheral blood has 1000 RBC per 1 WBC. Thus, CSF from traumatic taps should have approximately the same ratio.
– CSF glucose should be 0.6 of serum glucose.
– Empiric treatment of bacterial meningitis should include strep pneumoniae and neisseria meningitidis coverage. Add listeria coverage for age >50 and immunocompromised. Add pseudomonas coverage for history of instrumentation/trauma.
– Consider NMDA-receptor encephalitis in women presenting w/ altered mental status + psychosis, dyskinesias, seizure, autonomic instability.
– Here is a great article from Dr. Josep Dalmau of UPenn looking describing the course of 100 patients with NMDA-receptor encephalitis.