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A 23-year-old Caucasian woman presented acutely to the emergency department with mild confusion and recurring stereotyped seizures that comprised a tingling sensation in her right arm and leg, followed by a generalised tonic–clonic seizure. She had been diagnosed with anti-N-methyl D-aspartate (NMDA)-receptor encephalitis 4 years previously, having presented with psychosis and generalised convulsive status epilepticus that required intubation. She had made an excellent recovery with no further symptoms and had been maintained on methotrexate until 3 months previously when it was stopped as she was stable.
MR imaging of the brain was normal. Investigations for malignancy, including whole-body positron emission tomography/CT and transvaginal ultrasound, were normal. She was treated as a relapse with intravenous corticosteroids and plasma exchange. Repeat testing of her NMDA …
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