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Anti-NMDA Receptor Antibody Encephalitis Presenting with Unilateral Non-convulsive Status Epilepticus in a Male Patient.

Kim H, Ryu H, Kang JK - J Epilepsy Res (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Delta slowing was observed on the right hemisphere (A). After lorazepam injection, the delta slowing disappeared and clinical symptoms like confusion improved (B).
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f2-er-5-1-17: Delta slowing was observed on the right hemisphere (A). After lorazepam injection, the delta slowing disappeared and clinical symptoms like confusion improved (B).

Mentions: A 34-year-old previously healthy man initially complained of nonspecific headaches and mild fever for a month. Subsequently, he began to show intermittent confusional episodes. He sometimes had incoherent and meaningless speech, followed by complete recovery. He was admitted to our hospital for recurrent confusional episodes. On neurologic exam, the patient was alert but poorly responsive. 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. Laboratory tests including routine chemistry and electrolytes revealed no abnormalities. Brain magnetic resonance imaging showed abnormally high signal intensities in the right fronto-parietal gyri on FLAIR image. Gadolinium-enhanced T1-weighted images showed diffuse leptomeningeal enhancement in the righthemisphere (Fig. 1). Under an initial differential diagnosis of viral meningoencephalitis, intravenous acyclovir was begun. Twenty four hour video EEG monitoring was started due to fluctuating consciousness. EEG showed rhythmic delta waves in the right hemisphere. 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. Anti-NMDA antibody test was positive in the serum and CSF. Initially, he was treated with pulse dose of methyl-prednisolone (1g 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. After discharge, antiepileptic drugs and steroids were slowly tapered for 4 months. He returned to his normal life without any medication.


Anti-NMDA Receptor Antibody Encephalitis Presenting with Unilateral Non-convulsive Status Epilepticus in a Male Patient.

Kim H, Ryu H, Kang JK - J Epilepsy Res (2015)

Delta slowing was observed on the right hemisphere (A). After lorazepam injection, the delta slowing disappeared and clinical symptoms like confusion improved (B).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494990&req=5

f2-er-5-1-17: Delta slowing was observed on the right hemisphere (A). After lorazepam injection, the delta slowing disappeared and clinical symptoms like confusion improved (B).
Mentions: A 34-year-old previously healthy man initially complained of nonspecific headaches and mild fever for a month. Subsequently, he began to show intermittent confusional episodes. He sometimes had incoherent and meaningless speech, followed by complete recovery. He was admitted to our hospital for recurrent confusional episodes. On neurologic exam, the patient was alert but poorly responsive. 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. Laboratory tests including routine chemistry and electrolytes revealed no abnormalities. Brain magnetic resonance imaging showed abnormally high signal intensities in the right fronto-parietal gyri on FLAIR image. Gadolinium-enhanced T1-weighted images showed diffuse leptomeningeal enhancement in the righthemisphere (Fig. 1). Under an initial differential diagnosis of viral meningoencephalitis, intravenous acyclovir was begun. Twenty four hour video EEG monitoring was started due to fluctuating consciousness. EEG showed rhythmic delta waves in the right hemisphere. 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. Anti-NMDA antibody test was positive in the serum and CSF. Initially, he was treated with pulse dose of methyl-prednisolone (1g 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. After discharge, antiepileptic drugs and steroids were slowly tapered for 4 months. He returned to his normal life without any medication.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus