Meningioma preceding CASPR2 antibody limbic encephalitis with a stroke mimic: A case report

• Published in: Medicine (Baltimore) 2021-06, Vol.100 (23), p.e26241-e26241
• Main Authors: Lu, Xiao-Jin, Li, Ran, Chen, Yong-Xing, Xu, Xian-Kai, Shi, Bao-Lin
• Format: Article
• Language: English
• Subjects: Biomarkers - analysis; Biomarkers - blood; Clinical Case Report; Cognitive Dysfunction - etiology; Humans; Limbic Encephalitis - complications; Limbic Encephalitis - diagnosis; Magnetic Resonance Imaging - methods; Male; Membrane Proteins - analysis; Membrane Proteins - blood; Meningioma - complications; Meningioma - diagnosis; Middle Aged; Nerve Tissue Proteins - analysis; Nerve Tissue Proteins - blood; Paresis - etiology; Seizures - etiology; Seizures - physiopathology; Tomography, X-Ray Computed - methods
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000026241

Todd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room. We report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE. CASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE. The patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days). Remission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 days. Autoimmune encephalitis (AE) should be considered in cases of late-onset epilepsy following meningioma peritumoral brain edema and resection. A diagnosis of AE should be considered in patients presenting with stroke-like symptoms if the magnetic resonance imaging abnormality does not match a known vascular territory. Early and correct diagnosis is crucial because immunotherapy is usually effective for this disease.