Sorted By Test Name - Mayo Medical Laboratories

NMDCC
61513
insomnia, fear, delusions, mania, and paranoia frequently occur; drug-induced psychosis may be
suspected. Other behavioral changes include social withdrawal and stereotyped behavior. Amnesia and an
unusual language disorder (noncortical aphasia) are common. The behavioral changes in children may be
less specific and include temper tantrums and hyperactivity. Neurological disorders including seizures and
dystonia are frequent, and may be the presenting symptom. After these initial symptoms, in both adults
and children, decreased responsiveness ensues. Movement disorders include oro-lingual-facial
dyskinesias, generalized chorea, oculogyric crisis, dystonia, and rigidity. Autonomic manifestations
include hyperthermia, tachycardia, hypersalivation, hypertension, bradycardia, hypotension, urinary
incontinence, and erectile dysfunction. Hypoventilation may necessitate extended ventilatory support
(often months). Dissociative responses similar to those caused by NMDA-receptor antagonists (eg,
phencyclidine or ketamine) have been observed (eg, resisting eye opening despite lack of response to
painful stimuli). The female:male ratio of patients is about 8:1. Overall, ovarian teratoma is encountered
in approximately 50% of affected women. The most useful screening tests include magnetic resonance
imaging (MRI) of pelvis, computed tomography (CT) scan, and pelvic and transvaginal ultrasound. The
detection of teratoma is dependent on age and ethnic background; the younger the patient, the less likely
that teratoma will be detected; black women are more likely to have teratoma than other ethnic groups.
Only 2% have a neoplasm other than ovarian teratoma. Neoplasms documented in women include breast
adenocarcinoma, ovarian neuroendocrine tumors, sex cord stromal tumor, pseudopapillary neoplasm of
pancreas, neuroblastoma, and Hodgkin lymphoma. Neoplasia has been documented in 5% of men:
testicular germ cell tumors or small-cell lung carcinoma. Simultaneous testing of serum and cerebrospinal
fluid (CSF) is recommended, because CSF is often more informative for NMDA-receptor antibody.
Useful For: Evaluating new onset encephalopathy (noninfectious or metabolic) comprising 1 or more
of the following: confusional states, psychosis, delirium, memory loss, hallucinations, movement
disorders, seizures, or hypoventilation Evaluating limbic encephalitis Directing a focused search for
cancer Investigating encephalopathy appearing in the course or wake of cancer therapy, and not
explainable by metastasis or drug effect
Interpretation: This is a valuable serological marker of autoimmune encephalopathy and of a patient's
immune response to cancer (usually teratoma). NMDA-receptor autoantibodies are usually accompanied
by subacute neurological symptoms and signs, and not found in healthy subjects.
Reference Values:
Negative
Clinical References: Dalmau J, Lancaster E, Martinez-Hernandez E, et al: Clinical experience and
laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63-74
NMDA-Receptor Antibody by CBA, Spinal Fluid
Clinical Information: Patients with NMDA-receptor antibody (targeting the GluN1 [NR1] subunit of
this ionotropic glutamate receptor) have a fairly stereotyped neurological disorder, as described by
Dalmau and colleagues. This disorder often develops in several stages. Prodromal symptoms include
headache, fever, nausea, vomiting, diarrhea, or upper respiratory tract symptoms. Shortly afterwards,
patients develop psychiatric symptoms and many initially come to the attention of psychiatrists. Anxiety,
insomnia, fear, delusions, mania, and paranoia frequently occur; drug-induced psychosis may be
suspected. Other behavioral changes include social withdrawal and stereotyped behavior. Amnesia and an
unusual language disorder (noncortical aphasia) are common. The behavioral changes in children may be
less specific and include temper tantrums and hyperactivity. Neurological disorders including seizures and
dystonia are frequent, and may be the presenting symptom. After these initial symptoms, in both adults
and children, decreased responsiveness ensues. Movement disorders include oro-lingual-facial
dyskinesias, generalized chorea, oculogyric crisis, dystonia, and rigidity. Autonomic manifestations
include hyperthermia, tachycardia, hypersalivation, hypertension, bradycardia, hypotension, urinary
incontinence, and erectile dysfunction. Hypoventilation may necessitate extended ventilatory support
(often months). Dissociative responses similar to those caused by NMDA-receptor antagonists (eg,
phencyclidine or ketamine) have been observed (eg, resisting eye opening despite lack of response to
painful stimuli). The female:male ratio of patients is about 8:1. Overall, ovarian teratoma is encountered
in approximately 50% of affected women. The most useful screening tests include magnetic resonance
Current as of January 4, 2013 7:15 pm CST 800-533-1710 or 507-266-5700 or MayoMedicalLaboratories.com Page 1315