P 81 Voiding disorder – almond or walnut?

Abstract

Introduction Limbic encephalitis is an inflammatory disease of the central nervous system. The subacute development of short-term memory deficit is typical of this disease, as are psychiatric symptoms and seizures. Limbic encephalitis is caused by auto -immunity and is associated with cancer in about 60 per cent of cases. Since 1999, several antibodies associated with limbic encephalitis have been identified. Case report A 74-year-old patient was referred to our hospital because of urinary retention (residual urine volume: 840 ml) and disorientation. In the previous 4 months, he had developed short-term memory deficit and gait disturbance. A neurological examination, showed, ataxic gait, dysmetria of the right arm and leg, light paresis for the ab-/adduction of the fingers and dorsal flexion of the foot, and pallanesthesia of the malleolus. Neurological nerve conduction studies, electromyography and ultrasound revealed signs of neuropathy with axonal and demyelinating damage. After prostate resection the urinary retention did not improve. The spinal MRI did not show any significant cervical or lumbar stenosis. Cerebrospinal fluid showed a monocytic pleocytosis and an elevated protein. Also, positive oligoclonal bands GABA-B-Rezepor antibodies were detected isolated in the cerebrospinal fluid. A diagnostic search for cancer including imaging (PET-CT) and various tumor markers was negative. After treatment with metylprednisolone (500 mg for 5 days) and prednisolone (1 mg per kg with tapering doses), and IVIG (2 g per kg body weight over 5 days and 1 g per kg body weight over 2 days every four weeks), there was a rapid improvement of the voiding disorder to restored normal urine flow. Also, a slow improvement of the short-term memory deficit and a stabilization of the gait disturbance. Summary In conclusion, we diagnosed a GABAB receptor positive limbic encephalitis with polyneuropathy and possible transverse myelitis. In our opinion, this has not been described before.