Raffaele Iorio1, Eleonora Sabatelli2, Lucia Campetella2, Claudia Papi2. 1. From the UOC Neurologia (R.I.), Fondazione Policlinico Universitario A. Gemelli IRCCS; and Università Cattolica del Sacro Cuore (R.I., E.S., L.C., C.P.), Rome, Italy. raffaele.iorio@policlinicogemelli.it. 2. From the UOC Neurologia (R.I.), Fondazione Policlinico Universitario A. Gemelli IRCCS; and Università Cattolica del Sacro Cuore (R.I., E.S., L.C., C.P.), Rome, Italy.
Abstract
BACKGROUND AND OBJECTIVES: To report a case of anti-NMDAR encephalitis presenting with isolated memory dysfunction. METHODS: A 29-year-old woman was admitted to the Neurology Department referring memory impairment with a subacute onset. The initial assessment included EEG, neuropsychological tests, and brain MRI. Serum and CSF samples were collected for immunologic studies. The diagnostic evaluation was completed with a total body PET scan. RESULTS: Patient's neurologic examination was unremarkable apart from an episodic memory deficit, confirmed by neuropsychological examination. The EEG revealed epileptiform discharges in the temporal lobes, whereas brain MRI showed bilateral temporal lobes hyperintense lesions on fluid-attenuated inversion recovery images and T2-weighted images. NMDAR-IgG was detected in the patient's serum and CSF by cell-based assay confirming the diagnosis of definite anti-NMDAR encephalitis. The total body PET showed only a slight hypometabolism in the right temporal cortex and in the cerebellar hemispheres. After a course of IV immunoglobulin and corticosteroid therapy, a marked improvement of the memory deficit was observed. DISCUSSION: This case shows that anti-NMDAR encephalitis can present with isolated memory loss. Neural antibody testing in these patients could play a pivotal role in early diagnosis and prompt treatment.
BACKGROUND AND OBJECTIVES: To report a case of anti-NMDAR encephalitis presenting with isolated memory dysfunction. METHODS: A 29-year-old woman was admitted to the Neurology Department referring memory impairment with a subacute onset. The initial assessment included EEG, neuropsychological tests, and brain MRI. Serum and CSF samples were collected for immunologic studies. The diagnostic evaluation was completed with a total body PET scan. RESULTS: Patient's neurologic examination was unremarkable apart from an episodic memory deficit, confirmed by neuropsychological examination. The EEG revealed epileptiform discharges in the temporal lobes, whereas brain MRI showed bilateral temporal lobes hyperintense lesions on fluid-attenuated inversion recovery images and T2-weighted images. NMDAR-IgG was detected in the patient's serum and CSF by cell-based assay confirming the diagnosis of definite anti-NMDAR encephalitis. The total body PET showed only a slight hypometabolism in the right temporal cortex and in the cerebellar hemispheres. After a course of IV immunoglobulin and corticosteroid therapy, a marked improvement of the memory deficit was observed. DISCUSSION: This case shows that anti-NMDAR encephalitis can present with isolated memory loss. Neural antibody testing in these patients could play a pivotal role in early diagnosis and prompt treatment.
Authors: R Iorio; G Assenza; M Tombini; G Colicchio; G Della Marca; A Benvenga; V Damato; P M Rossini; C Vollono; D Plantone; A Marti; A P Batocchi; A Evoli Journal: Eur J Neurol Date: 2014-08-12 Impact factor: 6.089
Authors: Josep Dalmau; Amy J Gleichman; Ethan G Hughes; Jeffrey E Rossi; Xiaoyu Peng; Meizan Lai; Scott K Dessain; Myrna R Rosenfeld; Rita Balice-Gordon; David R Lynch Journal: Lancet Neurol Date: 2008-10-11 Impact factor: 44.182
Authors: Pitt Niehusmann; Josep Dalmau; Christian Rudlowski; Angela Vincent; Christian E Elger; Jeffrey E Rossi; Christian G Bien Journal: Arch Neurol Date: 2009-04
Authors: R Iorio; V Damato; G Spagni; G Della Marca; C Vollono; G Masi; C Papi; L Campetella; G Monte; A Evoli Journal: Eur J Neurol Date: 2020-06-19 Impact factor: 6.089
Authors: Michiel H F Poorthuis; Josephus L M van Rooij; Anna H Koch; Annelies E M Verdonkschot; Machteld M Leembruggen; Maarten J Titulaer Journal: Neurol Neuroimmunol Neuroinflamm Date: 2019-06-04
Authors: Francesc Graus; Maarten J Titulaer; Ramani Balu; Susanne Benseler; Christian G Bien; Tania Cellucci; Irene Cortese; Russell C Dale; Jeffrey M Gelfand; Michael Geschwind; Carol A Glaser; Jerome Honnorat; Romana Höftberger; Takahiro Iizuka; Sarosh R Irani; Eric Lancaster; Frank Leypoldt; Harald Prüss; Alexander Rae-Grant; Markus Reindl; Myrna R Rosenfeld; Kevin Rostásy; Albert Saiz; Arun Venkatesan; Angela Vincent; Klaus-Peter Wandinger; Patrick Waters; Josep Dalmau Journal: Lancet Neurol Date: 2016-02-20 Impact factor: 44.182