Publicação
Autoimmune Limbic Encephalitis
| Resumo: | Limbic encephalitis is a rare but increasingly recognized disorder. The sudden onset of symptoms such as confusion, cognitive impairment, irritability, depression, hallucinations, is one of the main characteristics. It is an inflammatory disease involving the temporal lobes, which explains the frequency of seizures. We report the case of a 27-year-old man, presenting hyperosmolar syndrome (owing to new onset diabetes mellitus), acute confusional state and sudden onset of seizures. Several diagnostic hypotheses were raised: infectious meningoencephalitis, autoimmune encephalitis, and metabolic encephalopathy. Despite treatment (antibiotics, correction of hyperosmolar state and anticonvulsant therapy), continuous cognitive deterioration and seizures persisted. We raised the hypothesis of an autoimmune limbic encephalitis by anti-GAD antibodies and treated with human immunoglobulin. There was a dramatic improvement, corroborating the diagnosis (along with imaging findings). Although difficult to diagnose, limbic encephalitis should be considered when studying acute confusional states with psychiatric symptoms and seizures. Clinical suspicion and early treatment are essential for therapeutic success. |
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| Autores principais: | Barbosa, Cristiana |
| Outros Autores: | Patrão, Luís; Bettencourt, Victor; Pereira, Sara; Domingues, Joana; Garrido, António |
| Assunto: | Doenças Autoimunes Encefalite Límbica Autoimmune Diseases Limbic Encephalitis |
| Ano: | 2015 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | unknown |
| Instituição associada: | Sociedade Portuguesa de Medicina Interna |
| Idioma: | português |
| Origem: | Revista Portuguesa de Medicina Interna |
| Resumo: | Limbic encephalitis is a rare but increasingly recognized disorder. The sudden onset of symptoms such as confusion, cognitive impairment, irritability, depression, hallucinations, is one of the main characteristics. It is an inflammatory disease involving the temporal lobes, which explains the frequency of seizures. We report the case of a 27-year-old man, presenting hyperosmolar syndrome (owing to new onset diabetes mellitus), acute confusional state and sudden onset of seizures. Several diagnostic hypotheses were raised: infectious meningoencephalitis, autoimmune encephalitis, and metabolic encephalopathy. Despite treatment (antibiotics, correction of hyperosmolar state and anticonvulsant therapy), continuous cognitive deterioration and seizures persisted. We raised the hypothesis of an autoimmune limbic encephalitis by anti-GAD antibodies and treated with human immunoglobulin. There was a dramatic improvement, corroborating the diagnosis (along with imaging findings). Although difficult to diagnose, limbic encephalitis should be considered when studying acute confusional states with psychiatric symptoms and seizures. Clinical suspicion and early treatment are essential for therapeutic success. |
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