Solitary juxtacortical lesion associated with anti-N-methyl-D-aspartate receptor encephalitis: a case report
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CASE REPORT
Open Access
Solitary juxtacortical lesion associated with anti-N-methyl-D-aspartate receptor encephalitis: a case report Rupan Gao1, Xiang Zhang2, Abhijeet Kumar Bhekharee3 and Yue Zhang2*
Abstract Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a severe autoimmune encephalitis mediated by anti-NMDA receptor antibodies. Brain MRI manifestations vary and are non-specific. If there are any lesions, they tend to be diffusely or multifocally distributed. Solitary lesion is relatively rare. Case presentation: We report a 16-year-old girl who initially presented with focal seizures but developed severe psychiatric and extrapyramidal symptoms later on. Brain MRI revealed a solitary juxtacortical demyelinating lesion in the left frontal lobe. No enhancement was noted. Electroencephalogram captured epileptiform discharges in the same region. NMDAR IgGs were tested positive in the serum and cerebrospinal fluid. Corticosteroid and intravenous IgG were administered and the patient completely recovered. Brain MRI revealed a fainter lesion in the left frontal lobe. Conclusion: In very rare instances, anti-NMDA receptor encephalitis can present with a solitary brain lesion. A full panel of antibodies for autoimmune encephalitis is the key leading to the diagnosis. Keywords: Seizure, Juxtacortical lesion, Demyelination, Electroencephalogram, Anti-N-methyl-D-aspartate receptor encephalitis
Background Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis was first described by Dalmau, et al., in 2007 [1]. Clinical picture covers a wide range of symptoms, including behavioral and psychiatric problems, memory loss, seizures, central hypoventilation, and movement disorders [1]. Brain MRI manifestations vary and are non-specific. More than half of the patients have normal MRI images [2]. If there are any brain lesions, they are more likely to be multifocal or diffuse [2, 3]. The most common finding on electroencephalogram (EEG) is diffuse slowing [4]. We herein report a case of anti-NMDA receptor * Correspondence: [email protected] 2 Department of Neurology, Huashan Hospital, Fudan University, No. 12 Mid Urumqi Road, Jin’an District, Shanghai 200040, China Full list of author information is available at the end of the article
encephalitis initially presenting with focal seizures and. a left frontal juxtacortical lesion after brain MRI.
Case presentation A 16-year-old girl presented to the emergency room with status epilepticus which was preceded by 10-daylong period of recurrent seizures. Ten days ago, she began to suffer from recurrent jerky movements in the right arm which sometimes evolved to generalized clonic-tonic seizures. Frequency and duration gradually increased despite the use of levetiracetam 500 mg Q12. Eventually, after the development of status epilepticus, she was sent to the emergency room where intravenous diazepam was injected. When she was transferred to the ward, she was sedated. Brain MRI revealed a left frontal unenhanced juxtacortical demyelinating lesion (Fig. 1 a, left an
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