Anti-NMDA receptor encephalomyelitis
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A 17-year-old female presented with two days of acute psychosis, which progressed to catatonia and unresponsiveness. During the first several days of inpatient admission, she experienced progressive bilateral extremity clonus, hyperreflexia, and urinary retention. Lumbar puncture revealed CSF lymphocyte-predominant pleocytosis and also oligoclonal bands, indicating an intrathecal synthesis of immunoglobulin. EEG showed generalized slowing with diffuse delta brushes, consistent with encephalopathy.

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