anti - nmda receptor antibody encephalitis is a recently recognized autoimmune encephalitis characterized by a prodromal phase of nonspecific illness with fever resembling viral disease , followed by memory loss , psychiatric features , seizures , disturbed consciousness , abnormal movements and autonomic imbalance . in 2008 , dalmau et al . various types of seizures occurred in 76%.1 among them , 45% were generalized tonic clonic seizures and 10% were partial complex seizures . electroencephalography ( eeg ) was reported to show generalized or fronto - temporal delta or theta slowing in 77% , and epileptic activity in 23% of patients.1 there have been only few reports of non - convulsive status epilepticus ( ncse ) related to anti - nmda receptor antibody encephalitis.25 we report a case of anti - nmda receptor antibody encephalitis with confusion , poor - orientation and unilateral rigidity , which correlated with unilateral rhythmic delta activity , and which was finally proven to be ncse . a 34-year - old previously healthy man initially complained of nonspecific headaches and mild fever for a month . pathologic reflexes were negative , but the muscle tone of the left arm and leg were slightly increased . analysis of cerebrospinal fluid ( csf ) identified 91 white blood cells / ml ( 80% lymphocytes ) and normal level of protein and glucose . brain magnetic resonance imaging showed abnormally high signal intensities in the right fronto - parietal gyri on flair image . after injection of lorazepam , delta waves on eeg disappeared and clinical symptoms improved , which was suggestive of ncse ( fig . 2 ) . phenytoin ( 300 mg / day ) , valproate ( 1,000 mg / day ) , topiramate ( 400 mg / day ) and levetiracetam ( 2,000 mg / day ) were used to control the seizure activity . initially , he was treated with pulse dose of methyl - prednisolone ( 1 g for 3 days and 500 mg for 2 days ) and steroids were tapered by dexamethasone ( 12 mg for 7 days , 9 mg for 3 days , 6 mg for 3 days and 3 mg for 3days ) . neck , chest , abdomen and pelvic computed tomography , and whole body positron emission tomography revealed no evidence of malignancy . his mental state markedly improved after antiepileptic medication but mild confusion lasted more than 2 weeks , which gradually disappeared with steroid therapy . the present case describes a young man with anti - nmda receptor antibody encephalitis who showed intermittent confusion and decreased responsiveness associated with unilateral ncse . reported various types of seizure in 76% of anti - nmda antibody encephalitis.1 status epilepticus was reported in 6% of patients . we recognized that our patient s unilateral delta activity might be ictal pattern of ncse due to the improvement of eeg and clinical status after intravenous lorazepam injection.6 there have been four case reports of non - convulsive status epilepticus due to anti - nmda receptor antibody encephalitis . discharges,2 two cases showed generalized theta to delta activity,3,4 and the other case showed unilateral 1 hz rhythmic right hemispheric delta activities as ncse pattern , similar to our case.5 titulaer et al reported that adult men more often ( 27% ) presented with seizure than adult woman ( 11% , p = 0.007 ) , who usually presented with abnormal behavior and psychiatric symptoms.7 the authors suggested hormonal factors and selection bias for the different sex - related symptom presentation . in conclusion , our case suggests that suspicion of the diagnosis of anti - nmda receptor encephalitis in adult men with unexplained mental status is needed . furthermore , eeg monitoring may be useful in cases of suspected anti - nmda receptor encephalitis even in the absence of overt seizures , given the possibility of ncse .
anti - n - methyl - d - aspartate ( nmda ) receptor antibody encephalitis is an autoimmune antibody encephalitis with psychiatric symptoms , memory disturbances , seizures and abnormal movements . 
 it is more common in young women . 
 we report a young man diagnosed as anti - nmda receptor antibody encephalitis and presenting with confusion due to non - convulsive status epilepticus involving unilateral hemisphere .