Thane, June 16: What began as a strange visual complaint in a healthy 28-year–old man soon evolved into a life-threatening neurological emergency, highlighting the importance of early diagnosis in rare autoimmune brain disorders.
The patient, who was preparing for his wedding, arrived at KIMS Hospitals, Thane, with an unusual concern. He reported that he was seeing the world as if through a “negative camera image,” where colours appeared inverted and visual perception seemed altered. Despite the disturbing symptom, comprehensive ophthalmological evaluations revealed no abnormalities in his eyes.
The unusual nature of the complaint prompted further neurological assessment by Dr. Nikhil Sharad Jadhav, Consultant Neurologist, KIMS Hospitals, Thane, who suspected that the symptom could represent an early manifestation of a neurological disorder rather than an eye-related problem.
Over the following days, the patient’s condition deteriorated rapidly. He began experiencing marked behavioural and personality changes, emotional instability, episodes of agitation, seizures, and progressive deterioration in consciousness. His condition eventually became severe enough to require intensive care and ventilator support.
The case proved particularly challenging because many of the initial investigations failed to provide clear answers. MRI scans of the brain appeared normal, and extensive testing for infectious causes did not reveal any abnormalities.
“One of the biggest challenges with autoimmune encephalitis is that it can initially mimic psychiatric illness, viral infections, or other neurological disorders. In many patients, routine investigations may appear normal in the early stages. Clinical suspicion becomes extremely important when symptoms evolve rapidly and do not fit a typical pattern,” said Dr. Nikhil Sharad Jadhav, Consultant Neurologist, KIMS Hospitals, Thane.
Based on the patient’s evolving symptoms and clinical presentation, Dr. Jadhav suspected autoimmune encephalitis and recommended specialised antibody testing early in the course of treatment. The tests later confirmed Anti-NMDA receptor autoimmune encephalitis, a rare autoimmune condition in which the body’s immune system mistakenly attacks receptors in the brain, leading to psychiatric, cognitive, and neurological symptoms.
Following confirmation of the diagnosis, the patient was started on immunotherapy and specialised neurological treatment. His condition gradually improved, and over the following weeks he made a remarkable recovery.
“Early recognition and timely treatment can dramatically change outcomes in autoimmune encephalitis. Delays in diagnosis may result in prolonged neurological impairment and, in severe cases, can be life-threatening. This case demonstrates how paying attention to unusual symptoms and acting early can make a significant difference,” added Dr. Jadhav.
Today, the patient has recovered substantially and has returned to planning his wedding, an outcome that doctors consider highly encouraging given the severity of his illness.
“Many people associate sudden behavioural changes, emotional disturbances, or psychiatric symptoms with primary mental health conditions. However, in some cases, these can be the earliest signs of an underlying neurological disorder. Unusual symptoms such as altered visual perception, new-onset seizures, confusion, or rapidly changing behaviour should never be ignored. Early neurological evaluation can be crucial in identifying rare but treatable conditions such as autoimmune encephalitis before they progress to severe complications,” said Dr. Nikhil Sharad Jadhav, Consultant Neurologist, KIMS Hospitals, Thane