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1/5 After the 2017 devastating Mexico earthquake, a 37-year-old man, aid volunteer, started to feel “weaker physically and mentally.” He felt fear & guilt because “he couldn’t provide help when people most needed it,” & speaked in whispers, saying that his voice “had become low.”
2/5 He exhibited headaches, insomnia, decreased appetite, irritability, auditory and visual hallucinations, mutism, paranoid and somatic delusions. He was admitted to the @innnmvs for self injurious behavior. He had no personal or familial history of psychiatric illness.
3/5 He had inattention and disorientation, psychomotor agitation, catatonia, fluctuating mental state & worsened with antipsychotics. His neurological examination was otherwise normal. Brain MRI was unremarkable. EEG showed a severe generalized slowing without epileptic activity.
4/5 He would state repeatedly: “I do not have feelings because I am dead.” He said that he had a “right-sided” heart & that it had stopped. A brain 18F-FDG PET study revealed prominent hypometabolism in the right occipito-parietal cortex,more accentuated in the right hemisphere.
5/5 CSF analysis showed pleocytosis. Infectious etiologies were excluded, and NMDAR antibodies were positive in CSF. He achieved a complete remission with immunotherapy. The details are in our new paper on #Cotard syndrome in anti-NMDAr #encephalitis: https://twitter.com/JRBneuropsiq/status/1346113869069082624?s=20
