CWH C1366348

 A

In anti-NMDA receptor encephalitis, a raised CK is not caused by the encephalitis itself.
When CK is elevated, it almost always reflects secondary muscle injury from features commonly seen in this condition.

Why CK Is Raised in Anti-NMDA Encephalitis

1. Prolonged or repeated seizures (most common)

Anti-NMDA encephalitis frequently presents with:

• generalized tonic-clonic seizures

• non-convulsive status that later generalizes
  These cause muscle breakdown → elevated CK.

2. Severe agitation / dyskinesias

Anti-NMDA encephalitis uniquely causes:

• violent or repetitive dyskinesias

• psychomotor agitation

• catatonic episodes with rigidity

These can produce significant muscle stress, leading to CK elevation and even rhabdomyolysis.

3. Medication-related syndromes

Patients are often treated with antipsychotics or sedatives to control agitation.

• Neuroleptic Malignant Syndrome (NMS)

  • rigidity, fever, autonomic instability

  • markedly high CK

• Serotonin syndrome (if serotonergic drugs used)

  • tremor, agitation, hyperreflexia

  • mild–moderate CK elevation

4. Immobility-related rhabdomyolysis

Reduced consciousness or catatonia → prolonged immobility → pressure-related muscle injury → CK elevation.

5. Less common: coexisting myositis

Rare reports of autoimmune myositis with anti-NMDA disease, but very uncommon.

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Bottom Line

In anti-NMDA encephalitis, a raised CK suggests a complication—most often seizures, severe dyskinesias, agitation, or NMS, rather than the encephalitis itself.

If you’d like, you can tell me the CK value and clinical context, and I can help interpret the likely cause.