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Early and persistent 'extreme delta brush' in a patient with anti-NMDA receptor encephalitis.

VanHaerents S, Stillman A, Inoa V, Searls DE, Herman ST - Epilepsy Behav Case Rep (2014)

Bottom Line: The presence of this pattern is associated with a more prolonged illness, although the specificity of this pattern is unclear.Additionally, the frequency and sensitivity of EDB in anti-NMDAR encephalitis and its implications for outcome have yet to be determined.We report a patient with early evidence of extreme delta brush and persistence of this pattern 17.5 weeks later with little clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

ABSTRACT
Since its original description in 2007, anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis associated with an ovarian teratoma is an increasingly recognized etiology of previously unexplained encephalopathy and encephalitis. Extreme delta brush (EDB) is a novel electroencephalogram (EEG) finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness, although the specificity of this pattern is unclear. Additionally, the frequency and sensitivity of EDB in anti-NMDAR encephalitis and its implications for outcome have yet to be determined. We report a patient with early evidence of extreme delta brush and persistence of this pattern 17.5 weeks later with little clinical improvement.

No MeSH data available.


Related in: MedlinePlus

Early EEG demonstrates frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves consistent with ‘extreme delta brush.’ There is also phase reversal on this bipolar montage over the right temporal lobe. This continuous EEG was captured on 7/07/2013 at 12:00 at a sensitivity of 5 μV/mm.
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f0010: Early EEG demonstrates frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves consistent with ‘extreme delta brush.’ There is also phase reversal on this bipolar montage over the right temporal lobe. This continuous EEG was captured on 7/07/2013 at 12:00 at a sensitivity of 5 μV/mm.

Mentions: In the neurological ICU, the patient was noted to frequent peri-oral movements. She remained unresponsive. She continued to have frequent right temporal sharp waves on EEG. Levetiracetam and lacosamide were added on. Additionally, her continuous EEG monitoring within the first few days began to demonstrate frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves (Fig. 2). This pattern of ‘extreme delta brush’ had been described as highly suggestive of anti-NMDAR encephalitis [5].


Early and persistent 'extreme delta brush' in a patient with anti-NMDA receptor encephalitis.

VanHaerents S, Stillman A, Inoa V, Searls DE, Herman ST - Epilepsy Behav Case Rep (2014)

Early EEG demonstrates frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves consistent with ‘extreme delta brush.’ There is also phase reversal on this bipolar montage over the right temporal lobe. This continuous EEG was captured on 7/07/2013 at 12:00 at a sensitivity of 5 μV/mm.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307880&req=5

f0010: Early EEG demonstrates frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves consistent with ‘extreme delta brush.’ There is also phase reversal on this bipolar montage over the right temporal lobe. This continuous EEG was captured on 7/07/2013 at 12:00 at a sensitivity of 5 μV/mm.
Mentions: In the neurological ICU, the patient was noted to frequent peri-oral movements. She remained unresponsive. She continued to have frequent right temporal sharp waves on EEG. Levetiracetam and lacosamide were added on. Additionally, her continuous EEG monitoring within the first few days began to demonstrate frontally maximal high-voltage beta activity superimposed on frontally maximal delta waves (Fig. 2). This pattern of ‘extreme delta brush’ had been described as highly suggestive of anti-NMDAR encephalitis [5].

Bottom Line: The presence of this pattern is associated with a more prolonged illness, although the specificity of this pattern is unclear.Additionally, the frequency and sensitivity of EDB in anti-NMDAR encephalitis and its implications for outcome have yet to be determined.We report a patient with early evidence of extreme delta brush and persistence of this pattern 17.5 weeks later with little clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

ABSTRACT
Since its original description in 2007, anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis associated with an ovarian teratoma is an increasingly recognized etiology of previously unexplained encephalopathy and encephalitis. Extreme delta brush (EDB) is a novel electroencephalogram (EEG) finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness, although the specificity of this pattern is unclear. Additionally, the frequency and sensitivity of EDB in anti-NMDAR encephalitis and its implications for outcome have yet to be determined. We report a patient with early evidence of extreme delta brush and persistence of this pattern 17.5 weeks later with little clinical improvement.

No MeSH data available.


Related in: MedlinePlus