Abstract Details

Title Extreme Delta Brush: The Key to Anti-NMDA Receptor Encephalitis

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 036

Objective

To describe a case in which extreme delta brush (EDB) prompted workup for anti-N-methyl-D-aspartate receptor encephalitis (NMDARe).

Background NMDARe typically presents with neuropsychiatric symptoms and is often associated with ovarian teratomas. Antibody testing is specific, but results are often delayed. EDB, a unique finding on an electroencephalogram (EEG) prompts evaluation for NMDARe to avoid misdiagnosis and prolonged illness. Here we describe an unusual presentation of recurrent electrographic seizures with behavioral changes which were thought to be secondary to an underlying temporal meningioma, but EDB on EEG prompted a workup for NMDARe.

Design/Methods Retrospective chart review and literature search.

Results 53-year-old woman with hypertension and left temporal meningioma presented to our hospital for 2 weeks of behavioral issues (non-verbal, hallucinations, difficulty feeding) and seizures. She was seen at a local hospital a week prior for profuse sweating and new onset of generalized tonic-clonic seizures (GTCS). A spot EEG showed left frontal electrographic seizures, which were thought to be secondary to a calcified left temporal meningioma. She was discharged home from the local hospital on two anti-seizure medications (levetiracetam and phenytoin). She was scheduled to undergo resection of the meningioma on the day of presentation when she had two episodes of GTCS. Initial EEG showed bifrontal rhythmic delta activity along with some right frontal electrographic seizures. Two days into admission, she started having frequent episodes of right arm twitching along with perseveration. Her clinical status rapidly deteriorated into refractory status epilepticus. Neurosurgery pursued left temporal meningioma resection; however electrographic seizures persisted. This prompted workup for autoimmune encephalitis with her cerebrospinal fluid NMDA-R antibody titer 1:64.

Conclusions Anti-NMDA-receptor encephalitis is a life-threatening condition that is treatable when diagnosed timely and immunosuppressive treatment is established promptly. Presence of EDB, although only present in a minority of patients, can streamline investigation and allow for rapid initiation of therapy.

Authors/Disclosures
Courtney Filliben PRESENTER	Ms. Filliben has nothing to disclose.
Prashant Natteru, MBBS (Mayo Clinic Health System)	Dr. Natteru has nothing to disclose.
Christa O'hana S. Nobleza, MD	Dr. Nobleza has nothing to disclose.

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Abstract Details