Recruitment lecture 12.20.19

Today we had a case of autoimmune encephalitis, in a patient with a recent viral illness presenting with refractory status. Although ruling out infectious causes of encephalitis is imperative, do not forget autoimmune encephalitis, the most characterized of which is anti-NMDA. There are many other antibodies and autoimmune encephalitis syndromes, but acute behavioral changes, seizures, language dysfunction and dyskinesias after a viral illness +/- CSF pleocytosis or classic MRI features – without alternative causes – should make you suspicious.

Our take home points were;

  • Know the broad differential categories for new onset seizures
  • EEG is an important tool to rule out non-convulsive status
  • There are many autoimmune encephalitides, including NMDA-R, that vary according to Ab target and clinical presentations
  • Paraneoplastic encephalitis often overlaps with autoimmune, however antibodies target intracellular proteins

 

SA

 

Picture from Fang and Juan, Neuroradiology 2019.

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