Periventricular white matter lesion and incomplete MRZ reaction in a male patient with anti-N-methyl-d-aspartate receptor encephalitis presenting with dysphoric mania

Several findings suggest that there may be an overlap of anti-N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis with neuromyelitis optica spectrum disorders or acute demyelinating encephalomyelitis (ADEM)-like demyelination. We present a case of a patient with anti-NMDAR antibody encephali...

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Bibliographic Details
Published in:BMJ case reports 2015-04, Vol.2015, p.bcr2014209075
Main Authors: Gahr, Maximilian, Lauda, Florian, Wigand, Moritz E, Connemann, Bernhard J, Rosenbohm, Angela, Tumani, Hayrettin, Reindl, Markus, Uzelac, Zeljko, Lewerenz, Jan
Format: Article
Language:English
Subjects:
Adult
Aggression
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnosis
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - immunology
Antibodies
Aquaporin 4 - immunology
Autoantibodies - metabolism
Cerebrospinal fluid
Encephalitis
Europe (West)
Humans
Immunoglobulin G - therapeutic use
Impulsivity
Leukocytes
Magnetic Resonance Imaging
Male
Myelin-Oligodendrocyte Glycoprotein - immunology
Nervous system
Neuroimaging
Neuromyelitis Optica - cerebrospinal fluid
Neuromyelitis Optica - complications
Neuromyelitis Optica - diagnosis
Neuromyelitis Optica - immunology
Patients
Psychosis
Rubella
Unusual Association of Diseases/Symptoms
Viral Vaccines - immunology
White
White Matter - pathology
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Summary:Several findings suggest that there may be an overlap of anti-N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis with neuromyelitis optica spectrum disorders or acute demyelinating encephalomyelitis (ADEM)-like demyelination. We present a case of a patient with anti-NMDAR antibody encephalitis, who on MRI featured a single prominent T2-hyperintensive white matter lesion in the periventricular region, adjacent to the anterior horn of the left lateral ventricle. In view of the lesion location and the cerebrospinal fluid (CSF) findings (incomplete MRZ (measles, rubella and varicella zoster) reaction, lymphocytic pleocytosis, intrathecal IgG and IgM synthesis; absence of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies), the presence of a multiple sclerosis-like immune response was discussed. This case appears to add evidence to the hypothesis of an overlap between anti-NMDAR antibody encephalitis and other inflammatory central nervous system diseases.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-209075