How is encephalitis differentiated from schizophrenia?

Updated: Mar 16, 2018
  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
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Encephalitis related to paraneoplastic or autoimmune disorders can be confused with schizophrenia.

Of the several paraneoplastic neurologic syndromes, one of them, limbic encephalitis, an inflammation of the limbic system, is particularly likely to be misdiagnosed as schizophrenia. People with this disorder can experience emotional or personality changes, memory problems, hallucinations, odd motor movements, or sleep disturbances. Acuteness of onset, seizures, and EEG and MRI changes differentiate this syndrome from schizophrenia. The syndrome often develops before any evidence of malignancy and is caused by antibodies to tumor cells that cross-react with antigens within the brain.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis usually begins with a headache and or fever, and is followed by agitation, odd behavior, and impaired memory. Symptoms that differ from those seen in schizophrenia include seizures, decreased level of consciousness, dyskinesias, and autonomic instability. A variety of other neurological symptoms may develop. EEG, MRI, and CSF may be abnormal.

About one half of women with anti-NMDAR encephalitis have an ovarian teratoma. The illness may remit after removal of the tumor. Other cases of anti-NMDAR encephalitis may be associated with a viral infection, particularly the herpes simplex virus. The syndrome is caused by antibodies reacting to a subunit of the NMDAR in the brain.

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