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Neurological Rehabilitation

The Role of Acute Inpatient Rehabilitation in NMDA Encephalitis: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Primary Author(s)

  • CHRISTINE RYAN, PhD

    Medical Student
    University of Miami Miller School of Medicine
    Miami, Florida

    • Poster Presenter(s)

  • Matison Alderman, MD

    Resident physician, PGY-4
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

    • Co-Author(s)

  • GA

    Gemayaret Alvarez, MD

    Associate Professor
    University of Miami Health System
    Miami, Florida

Disclosure(s):
CHRISTINE RYAN, PhD: No financial relationships to disclose
Case Diagnosis: NMDA-Receptor Encephalitis

Case Description or Program Description: A 30-year-old female admitted to a psychiatric unit at an outside hospital for psychosis with paranoid delusions. Her clinical status deteriorated with persistent altered mentation and seizures. She was later found to be in status epilepticus, requiring prolonged intubation. Brain MRI showed T2 changes in left temporal lobe extending superiorly into the sub-insular cortex. CSF was positive for Anti-NMDAR antibodies, and she was treated with steroids, plasmapheresis, and IVIG. Her hospital course was complicated by difficulties with extubation, requiring tracheostomy placement, and MRSA bacteremia and pneumonia. Patient was discharged and presented to our hospital system for a second opinion, she was stabilized, decannulated and discharged to acute inpatient rehabilitation.

Setting: Acute inpatient rehabilitation

Assessment/Results: Admission to neurorehabilitation was two months after initial hospital admission for impairments in motor, cognitive, neuropsychological function. The patient improved her strength, balance and endurance, and increased functional independence in ADLs. Speech-language pathology and neuropsychology noted cognitive deficits, further complicated by limited insight into her condition. By discharge, she showed improvement in impulsivity and emotional regulation and received education on cognitive support strategies but continued to have impairments in memory, language, and executive function.

Discussion (relevance): NMDA receptor encephalitis affects multiple spheres including motor, cognitive and psychological function. Previous studies have shown that despite rapid recovery of neurological deficits, the cognitive and psychiatric sequelae of this condition can persist long term, on the order of months to years. This time course is consistent with our patient’s rapid recovery of motor function, compared to ongoing cognitive and psychiatric issues at discharge.

Conclusions: Neurorehabilitation for NMDA receptor encephalitis requires a multidisciplinary approach. Recovery of motor and neurological function may precede the resolution of cognitive and psychological impairments, however this case highlights the role of neurorehabilitation in patients with this rare disorder, with a near missed opportunity to foster these functional gains.