Patient 29/ Female admitted with complaints of fever with chills, altered sensorium and nausea since 2 days. Complete fever profile negative.MRI CSF studies done normal. Patient throwed focal seizures with general examination normal and systemic examination showed no neurodeficit. Twice MRI and CSF done normal. With HSv-PCr Negative.  EEG done s/o Continuous slow waves showing generalized theta to delta range slowing with serrated appearance of delta waves (due to overriding fast beta activity) in frontal area representing extreme delta brush. ANTI-TPO antibodies, Thyroglobulin antibodies was negative NMDA receptor antibody was negative. All these symptoms fitted under category of autoimmune encephalitis. Patient improved with injectable and oral steroids.

Keywords: autoimmune, delta, focal, seizures.

1. Dalmau, A. J. Gleichman, E. G. Hughes et al., “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies,” The Lancet Neurology, vol. 7, no. 12, pp. 1091–1098, 2008. 
2. -P. Wandinger, S. Saschenbrecker, W. Stoecker, and J. Dalmau, “Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis,” Journal of Neuroimmunology, vol. 231, no. 1-2, pp. 86–91, 2011.
3. J. Titulaer, L. McCracken, I. Gabilondo et al., “Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study,” The Lancet Neurology, vol. 12, no. 2, pp. 157–165, 2013. 
4. Maneta and G. Garcia, “Psychiatric manifestations of Anti-NMDA receptor encephalitis: neurobiological underpinnings and differential diagnostic implications,” Psychosomatics, vol. 55, no. 1, pp. 37–44, 2014
5. S. Kayser, M. J. Titulaer, N. Gresa-Arribas, and J. Dalmau, “Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-D-aspartate receptor encephalitis,” JAMA Neurology, vol. 70, no. 9, pp. 1133–1139, 2013. 

Dr Sayali Kusalkar