engleski

AUTOIMMUNE ENCEPHALITIS: A CASE REPORT

Introduction/Objectives: Autoimmune encephalitis is an inflammatory disorder of the brain that may be associated with neuronal antibodies against neuronal cell surface or synaptic proteins. The most common receptors are the N-methyl-aspartate receptor (NMDAR), alfa-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid receptor (AMPAR), gama- aminobutric acid-B receptor (GABABR), leucine- rich glioma inactivated protein 1 (LGI1), contactin-associated protein-like 2 (CASPR2), metabotrophic glutamate receptor 5 (mGluR5), dipeptidyl-peptidase-like protein-6 (DPPX), gama-aminobutyric acid –A receptor (GABAAR), glutamic acid decarboxylase (GAD65). GAD65 and GABAAR are associated with a severe form of encephalitis with refractory epilepsy and status epilepticus. Case report: A 30-year-old female patient, previously healthy, presented with a generalised tonic-clonic seizure and she was admitted to the intesive care unit. After the seizure her consciousness was still impaired to the level of sopor, she was confused, restless and had occasional eye movements. She reacted with withdrawal and grimacing to painful stimulus. Deep tendon reflexes were normal. Her mental status was significantly impaired (nonverbal, not following commands) the second day after the admission. Nine days before the illness she gave birth to a healthy baby. She was treated with acyclovir, methylprednisolone and intravenous immune globulin for five days. Nonconvulsive status epilepticus lasted for 24 hours and stopped after intravenous administration of levetiracetam. Intravenous immune globulin treatment was repeated after two months. Routine haematological and biochemical analysis were unremarkable. CT and MRI of brain with contrast were normal. EEG showed continuous rhythmic delta waves 2-3 Hz and periodical rhytmic spike-wave activity over left frontotemporal region and periodical epileptiform discharges. These changes periodically occured over right frontotemporoparietal region. Cerebrospinal fluid analysis showed mild pleocytosis (mononuclear cells 24/mm3, polymorphonuclear cells 5/mm3) and normal protein and glucose levels. Serum and cerebrospinal fluid serological tests for Chlamydia pneumoniae, Mycoplasma pneumoniae, Borrelia burgdorferi and neurotropic viruses were negative. Anti-GAD antineuronal antibodies in serum were positive (97, 6 IU/mL). NMDA, VGKC, AMPA, tumor markers and syphilis test were negative. Conclusions: We reported a case of autoimmune encephalitis associated with GAD antibodies and a severe form of encephalitis and refractory non convulsive status epilepticus. The patient was fully recovered after the treatment with levetiracetam, oxcarbazepine and intravenous immune globulin. She had no more epileptic seizures and no neurological impairment.

autoimmune encephalitis

nije evidentirano