Case report: anti-N-Methyl-D-Aspartate receptor encephalitis and bilateral temporal calcifications
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CASE REPORT
Open Access
Case report: anti-N-Methyl-D-Aspartate receptor encephalitis and bilateral temporal calcifications Yujie Bu, Tinghua Zhang and Jia Guo*
Abstract Background: In this study, we report a case of a young female who was hospitalized for seizures and diagnosed with anti–N-methyl-D-aspartate receptor (NMDAR) encephalitis. Case presentation: The main feature of this patient was bilateral temporal calcifications detected by routine head computed tomography (CT). The co-existence of anti-NMDAR encephalitis and cerebral calcifications has not been reported. We supposed that the patient had an incomplete form of celiac disease (CD), epilepsy and cerebral calcifications syndrome (CEC). The patient's symptoms were alleviated by a series of treatments, and she remained stable during the follow-ups. Conclusions: Our findings confirm the rarity co-existing anti-NMDAR encephalitis and cerebral calcifications. In future clinical work, we need to elucidate the relationship between anti-NMDAR encephalitis and cerebral calcifications, and the association between anti-NMDAR encephalitis and other co-existing autoimmune disorders. Keywords: Anti-NMDAR encephalitis, Epilepsy, Bilateral temporal calcifications, CEC
Background Anti-NMDAR encephalitis is an immune-mediated disorder that was first reported in 2007 in patients with psychiatric symptoms, amnesia, seizures, abnormal movements, autonomic dysfunction, and decreased level of consciousness or hypoventilation [1]. Since then, a rapid expansion occurred in the number of anti-NMDA R encephalitis cases reported, with or without an associated tumor. Anti-NMDAR encephalitis is more frequent in epilepsy seizures than other types of autoimmune encephalitis [2]. We treated a female patient with antiNMDAR encephalitis who was hospitalized for seizures. The CT of her brain showed bilateral temporal calcifications.
* Correspondence: [email protected] Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China
The association between epilepsy and cerebral calcifications has been extensively studied [3, 4]. In 1992, Gobbi et al. [5] first described the triad of CD, epilepsy, and posterior cerebral calcification and named it CEC in 2005 [6]. Based on the manifestations and imaging findings of our patient, we presumed that our patient suffered from an incomplete form of CEC. Following adherence to a strict gluten-free diet (GFD), along with prednisone and antiepileptic drug administration, the patient's symptoms were alleviated and remained stable during the follow-ups. Importantly, anti-NMDAR encephalitis co-existing with cerebral calcifications has not been previously reported. Therefore, this case provides critical insights into the possibility that cerebral calcifications might be a nonspecific manifestation of NMDAR encephalitis or a disease co-existing with anti-NMDAR encephalitis.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing,
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