Gandarilla-Martínez NA, Martínez-Díaz BA, Espinosa-Aguilar L, Zúñiga-Varga J, Smirnov-Castro AI, Collado-Ortiz MA

Language: Spanish
References: 13
Page: 14-18
PDF size: 367.88 Kb.

ABSTRACT

Encephalitis is an inflammatory process of the brain parenchyma that can be either infectious or autoimmune. It presents with headache, fever, altered mental status, focal neurological deficits and seizures. The pattern of neurological involvement is useful in the clinical approach. We present the case of a 32-year-old male who presented with limbic encephalitis but unilateral temporal involvement. During the clinical course he developed autonomic instability, facial dyskinesias, chorea, myoclonus and tremor. The microbiological study was negative for viruses (including herpes virus type 1), bacteria and fungi. Antibodies against N-methyl-D-aspartate and intraneuronal antibodies in cerebrospinal fluid were negative. He was treated with antibiotics and antivirals with gradual improvement of symptoms over a period of two weeks without evidence of relapse and without the need for immunomodulatory treatment. Although it was not possible to identify a causative agent, we consider that the patient's clinical picture was secondary to an infectious process due to its self-limited nature and the good response to antimicrobials.

REFERENCES

1. Venkatesan A, Geocadin RG. Diagnosis and management of acute encephalitis: a practical approach. Neurol Clin Pract. 2014; 4 (3): 206-215.

2. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ et al. Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012; 64 (4): 347-373.

3. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016; 15 (4): 391-404.

4. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000; 123 (Pt 7): 1481-1494.

5. Armangue T, Leypoldt F, Dalmau J. Autoimmune encephalitis as differential diagnosis of infectious encephalitis. Curr Opin Neurol. 2014; 27 (3): 361-368.

6. Serrano-Cardenas KM, Sánchez-Rodriguez A, Pozueta A, Pelayo AL, Riancho J. Mesial encephalitis: an uncommon presentation of neurosyphilis: a case report and review of the literature. Neurol Sci. 2018; 39 (1): 173-176.

7. Zoccarato M, Valeggia S, Zuliani L, Gastaldi M, Mariotto S, Franciotta D et al. Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma. Neuroradiology. 2019; 61 (8): 853-860.

8. Adler AC, Kadimi S, Apaloo C, Marcu C. Herpes simplex encephalitis with two false-negative cerebrospinal fluid PCR tests and review of negative PCR results in the clinical setting. Case Rep Neurol. 2011; 3 (2): 172-178.

9. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008; 7 (12): 1091-1098.

10. Baizabal-Carvallo JF, Jankovic J. Autoimmune and paraneoplastic movement disorders: an update. J Neurol Sci. 2018; 385: 175-184.

11. Bradshaw MJ, Venkatesan A. Herpes simplex virus-1 encephalitis in adults: pathophysiology, diagnosis, and management. Neurotherapeutics. 2016; 13 (3): 493-508. doi: 10.1007/s13311-016-0433-7.

12. Lenka A, Kamat A, Mittal SO. Spectrum of movement disorders in patients with neuroinvasive west nile virus infection. Mov Disord Clin Pract. 2019; 6 (6): 426-433. doi: 10.1002/mdc3.12806.

13. Sarkari NB, Thacker AK, Barthwal SP, Mishra VK, Prapann S, Srivastava D et al. Japanese encephalitis (JE). Part I: clinical profile of 1,282 adult acute cases of four epidemics. J Neurol. 2012; 259 (1): 47-57.