A rare cause of encephalitis with hypothermia and hyponatremia
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LETTER TO THE EDITOR
A rare cause of encephalitis with hypothermia and hyponatremia Manal Elgendy1 · Shakya Bhattacharjee1 · Stuart J. Weatherby1 · Daniel J. Lashley1 Received: 15 February 2020 / Accepted: 27 May 2020 © Belgian Neurological Society 2020
Keywords Autoimmune · Encephalitis · Hypothermia · Hyponatremia · Immunoglobulin An elderly Caucasian man was admitted with new-onset facio-brachial-dystonic seizures (FBDS) and behavioral disturbances for 5 months. The seizure frequency was 1–2 weekly. She never had any loss of consciousness. The seizure started with a dystonic neck posturing followed by the left upper limb jerking. The clinical examination showed no focal abnormalities. The magnetic resonance imaging (MRI) of the brain revealed high T2 signals of the mesial temporal structures bilaterally (left more than right Fig. 1a). The 20 min of the routine EEG showed no obvious epileptiform activity. The lumbar puncture showed normal cell count, glucose, protein, and cytology. He was started on prednisolone 60 mg once daily and levetiracetam 250 mg twice daily. Levetiracetam was gradually increased to 1000 mg twice daily in the next 5 days. This resulted in the complete cessation of seizures. However, the behavioral disturbances persisted. Five days after the admission, he developed hypothermia without shivering and piloerection. The average core body temperature was less than 35 degrees Celsius (lowest temperature of 33 degrees). The routine investigations ruled out sepsis and any endocrinological cause. The serum sodium (Na) dropped from 134 mmol/l (during admission) to 117 mmol/l in 5 days. The paired urine and serum osmolality testing revealed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The core body temperature normalized after 4 days of intravenous immunoglobulin infusion. The serum Na slowly came up to 134 mmol/l after the immunoglobulin therapy and fluid restriction. The computed tomogram of the thorax, abdomen, and pelvis showed Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13760-020-01390-7) contains supplementary material, which is available to authorized users. * Shakya Bhattacharjee [email protected] 1
Department of Neurology, University Hospital Plymouth NHS Trust, Plymouth PL6 8DH, UK
no obvious source of malignancy. The whole-body positron emission tomogram (PET) was also normal (supplementary figure). The paraneoplastic antibodies screening was negative. However, serum voltage-gated potassium channel (VGKC) complex antibody was detected with a high leucinerich glioma-inactivated 1 (LGI1) antibody titer. A repeat course of the IVIg was previously reported to be helpful in autoimmune encephalitis with incomplete recovery [1]. The second course of intravenous immunoglobulin (total dose of 2 g/kg over 5 days) was given 6 weeks after the first course as the behavioral disturbances (suspected to be due to the auto-immune encephalitis) persisted in our patient. The prednisolone 60 mg daily was continued in b
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