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Bilateral thalamic changes in anti-NMDAR encephalitis presenting with hemichorea and dystonia and acute transient psychotic disorder
Journal of Neuroimmunology ( IF 2.9 ) Pub Date : 2020-10-01 , DOI: 10.1016/j.jneuroim.2020.577329 Souvik Dubey 1 , Ritwik Ghosh 2 , Mahua Jana Dubey 3 , Samya Sengupta 4 , Julián Benito-León 5 , Biman Kanti Ray 1
Journal of Neuroimmunology ( IF 2.9 ) Pub Date : 2020-10-01 , DOI: 10.1016/j.jneuroim.2020.577329 Souvik Dubey 1 , Ritwik Ghosh 2 , Mahua Jana Dubey 3 , Samya Sengupta 4 , Julián Benito-León 5 , Biman Kanti Ray 1
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Abstract Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is one of the most common causes of autoimmune encephalitis. Both movement disorders and neuropsychiatric manifestations are considered core features of anti-NMDAR encephalitis. Strong clinical suspicion, along with NMDAR antibody positivity in paired sample of serum and cerebrospinal fluid, with supportive MRI changes clinch diagnosis in majority. We herein report a case of a middle-aged woman with subacute behavioral abnormalities, which were so severe that forced her to attempt suicide. Hemichorea and dystonia, which appeared later in course, are not previously reported movement disorders in combination in anti-NMDAR encephalitis. Further, magnetic resonance imaging showed bilateral thalamic hyperintensities with diffusion restriction, which are in turn not described in this entity. After amalgamation of history, especially the presence of neuropsychiatric symptoms, clinical features, physical examination, and investigations, the diagnosis of anti-NMDAR encephalitis could be established. Our case not only highlights that the combination of hemichorea and dystonia can be features of anti-NMDAR encephalitis, but adds novelty by bilateral symmetric thalamic changes.
中文翻译：
抗 NMDAR 脑炎的双侧丘脑变化，表现为偏侧舞蹈症、肌张力障碍和急性短暂性精神病
摘要 抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎是自身免疫性脑炎最常见的原因之一。运动障碍和神经精神表现都被认为是抗 NMDAR 脑炎的核心特征。强烈的临床怀疑，加上血清和脑脊液配对样本中 NMDAR 抗体呈阳性，以及支持性 MRI 变化，可以确定大多数人的诊断。我们在此报告一例患有亚急性行为异常的中年妇女，该异常非常严重，迫使她试图自杀。偏侧舞蹈症和肌张力障碍是病程较晚出现的，以前没有报道过抗 NMDAR 脑炎合并运动障碍。此外，磁共振成像显示双侧丘脑高信号并伴有扩散限制，而本实体中未对此进行描述。综合病史，尤其是神经精神症状、临床特征、体格检查和调查，可以确定抗 NMDAR 脑炎的诊断。我们的病例不仅强调偏侧舞蹈症和肌张力障碍可能是抗 NMDAR 脑炎的特征，而且通过双侧对称丘脑变化增加了新颖性。
更新日期：2020-10-01
中文翻译：
抗 NMDAR 脑炎的双侧丘脑变化，表现为偏侧舞蹈症、肌张力障碍和急性短暂性精神病
摘要 抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎是自身免疫性脑炎最常见的原因之一。运动障碍和神经精神表现都被认为是抗 NMDAR 脑炎的核心特征。强烈的临床怀疑，加上血清和脑脊液配对样本中 NMDAR 抗体呈阳性，以及支持性 MRI 变化，可以确定大多数人的诊断。我们在此报告一例患有亚急性行为异常的中年妇女，该异常非常严重，迫使她试图自杀。偏侧舞蹈症和肌张力障碍是病程较晚出现的，以前没有报道过抗 NMDAR 脑炎合并运动障碍。此外，磁共振成像显示双侧丘脑高信号并伴有扩散限制，而本实体中未对此进行描述。综合病史，尤其是神经精神症状、临床特征、体格检查和调查，可以确定抗 NMDAR 脑炎的诊断。我们的病例不仅强调偏侧舞蹈症和肌张力障碍可能是抗 NMDAR 脑炎的特征，而且通过双侧对称丘脑变化增加了新颖性。
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