Anti-NMDA Receptor Encephalitis — Diagnostic Testing Instructions — Clinical Pathway: Inpatient

Anti-NMDA Receptor Encephalitis Clinical Pathway — Inpatient

Diagnostic Testing Instructions

Antibody tests should ideally be sent before IVIG or plasma exchange is given.

  Instructions Comments
Serum
  • CBC
  • CMP
  • Anti-NMDA antibodies:
    • Send to HUP
  • Autoimmune encephalopathy panel:
    • Send to Mayo
    • Minimum volume, 1 mL
 —
CSF
May have normal cell counts or modest pleocytosis		 Test Tube # Minimum Volume —
Cell Count and Differential Tube 1, 4 1 mL If there is limited CSF available, prioritize the CSF cell count/differential and autoimmune encephalopathy panel
Protein, Glucose Tube 3 0.3 mL —
Autoimmune Encephalopathy Panel
Send to Mayo		 Tube 2 2 mL If there is limited CSF available, prioritize the CSF cell count/differential and autoimmune encephalopathy panel
Anti-NMDA Antibodies
Send to HUP		 Tube 2 1 ml —
HSV PCR Tube 2 0.25 mL For viral PCRs, submit separate orders for these tests at the time of collection
Oligoclonal Bands
Also Need Serum		 Tube 2 0.25 mL Oligoclonal bands may be a prognostic factor in terms of severity
CSF Gram Stain and Culture Tube 2 0.2-0.5 mL —
Save Our Specimen Tube 2 2 mL The “Save Our Specimen” order should be linked to Tube 2, as this tube is kept under sterile conditions in Microbiology and can be used for further testing such as PCR testing when needed
MRI Brain with/without contrast
  • MRI is typically normal
  • Some children have increased T2 signal in the temporal lobes, insula, or other brain regions
EEG Standard routine or overnight May have epileptiform abnormalities, extreme delta brush, or may be normal