Encephalitis Presenting Research Articles

A Rare Presentation of Herpes Simplex Virus Encephalitis With Ischemic Stroke and Associated Acyclovir-Induced Acute Kidney Injury

A Rare Presentation of Herpes Simplex Virus Encephalitis With Ischemic Stroke and Associated Acyclovir-Induced Acute Kidney Injury

Rocky Mountain Spotted Fever Encephalitis and "Starry Sky" Pattern on MRI: A Case Report.

Rocky Mountain Spotted Fever (RMSF) is a tick-borne disease caused by Rickettsia rickettsii (R. rickettsii). RMSF presents after a tick bite with fever, rash, and headache but can also cause more serious neurological manifestations. We report a case of RMSF encephalitis presenting with altered sensorium and rapid progression to coma, fever, and petechial rash, and an magnetic resonance imaging (MRI) brain notable for a "starry sky" pattern. A 61-year-old woman presented with confusion and fever and was diagnosed with a urinary tract infection. Two days later, she became comatose. MRI brain revealed lacunar infarcts in the right centrum semiovale and splenium of the corpus callosum. Lumbar puncture was notable for neutrophilic pleocytosis and elevated protein with negative bacterial and viral cultures. Empiric meningitis therapy was initiated, and she was transferred to our institution. On transfer, she was febrile, comatose, and had a diffuse petechial rash. Repeat MRI brain demonstrated diffuse, innumerable punctate foci of diffusion restriction with susceptibility-weighted signal attenuation throughout cerebral hemispheres in a "starry sky" pattern. Skin biopsy revealed perivascular lymphocytic infiltrates. Serologic RSMF antibody titers were obtained, and doxycycline was initiated for presumed RMSF encephalitis. The family opted to pursue palliative measures, given no clinical improvement. RSMF titers and postmortem PCR from brain tissue were positive for R. rickettsii. This case report highlights the clinical presentation of RMSF encephalitis. RMSF encephalitis should be suspected in a patient presenting with encephalopathy, fever, petechial rash, and MRI brain findings of diffuse punctate foci of diffusion restriction and susceptibility-weighted signal attenuation in a "starry-sky" pattern.

Diagnostic Challenges in Atypical Rasmussen’s Encephalitis (RE) Presenting with Brainstem Involvement

Diagnostic Challenges in Atypical Rasmussen’s Encephalitis (RE) Presenting with Brainstem Involvement

Adenylate Kinase-5 (AK5) Antibody Encephalitis Presenting as a Rapidly Progressive Amnestic Syndrome

Adenylate Kinase-5 (AK5) Antibody Encephalitis Presenting as a Rapidly Progressive Amnestic Syndrome

Clinical characteristics and outcomes of patients with antibody-related autoimmune encephalitis presenting with disorders of consciousness: A prospective cohort study.

To explore the clinical characteristics, short- and long-term functional outcomes, and risk factors for antibody-related autoimmune encephalitis (AE) in patients with disorders of consciousness (DoC). Clinical data were collected from AE patients admitted to Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, and patients were followed up for up to 24 months after immunotherapy. A total of 312 patients with AE were included: 197 (63.1%) with anti-NMDAR encephalitis, 71 (22.8%) with anti-LGI1 encephalitis, 20 (6.4%) with anti-GABAbR encephalitis, 10 (3.2%) with anti-CASPR2 encephalitis, 10 (3.2%) with anti-GAD65 encephalitis, and 4 (1.3%) with anti-AMPAR2 encephalitis. Among these patients, 32.4% (101/312) presented with DoC, and the median (interquartile range, IQR) time to DoC was 16 (7.5, 32) days. DoC patients had higher rates of various clinical features of AE (p < .05). DoC was associated with elevated lumbar puncture cerebrospinal fluid (CSF) pressure, CSF leukocyte count, and specific antibody titer (p < .05). A high percentage of patients in the DoC group had a poor prognosis at discharge and at 6 months after immunotherapy (p < .001), but no significant difference in prognosis was noted between the DoC group and the non-DoC group at 12 and 24 months after immunotherapy. Dyskinesia (OR = 3.266, 95% CI: 1.550-6.925, p = .002), autonomic dysfunction (OR = 5.871, 95% CI: 2.574-14.096, and p < .001), increased CSF pressure (OR = 1.007, 95% CI: 1.001-1.014, p = .046), and modified Rankin scale (mRS) score ≥3 at the initiation of immunotherapy (OR = 7.457, 95% CI: 3.225-18.839, p < .001) were independent risk factors for DoC in AE patients. DoC is a relatively common clinical symptom in patients with AE, especially critically ill patients. Despite requiring longer hospitalization, DoC mostly improves with treatment of the primary disease and has a good long-term prognosis after aggressive life support and combination immunotherapy.

Reversible Cytotoxic Edema in Patients with COVID-19 Associated Encephalitis Presenting Status Epilepticus

Coronavirus disease 2019 (COVID-19) is a serious infectious disease with multisystem alteration including neurological complications. COVID-19 associated encephalitis is a potentially fatal viral infection of the brain. Diffusion-weighted images (DWI) are a useful evaluation modality of cytotoxic edema in patients with encephalitis. We report on the reversible DWI change in a patient with COVID-19 associated encephalitis, who had diffused cytotoxic edema in the affected temporal lobe and accompanied status epilepticus. Sequential imaging showed that the cytotoxic edema in DWI confirmed recovery to normal after 12 days in the presence of cortical edema in fluid-attenuated inversion recovery image after aggressive neurocritical management. Thus, prompt, proper management is indispensable during the acute period and DWI may be a valuable tool for reflecting the clinical course of COVID-19 associated encephalitis.

A child with anti-N-methyl-D-aspartate autoimmune encephalitis presenting with frank psychosis: a case report

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is the most common autoimmune encephalitis in children. The clinical manifestations and disease course of pediatric anti-NMDA receptor encephalitis have been comprehensively desibed in the literature and showed some differences compared with adult patients in tumor association, neurological presentation, and frequency of symptoms. In general, neurological symptoms were more common than psychiatric symptoms as the initial signs of presentation in children in most of the previous cohorts. They also tend to present with behavior changes, temper tantrums, hyperactivity, and irritability, instead of overt psychotic symptoms. In this article, we report a 12 years old boy with Anti NMDA encephalitis, showing a rare initial presentation of pure psychosis, after obtaining the consent of his parents.

Teaching NeuroImage: Anti-NMDA Receptor Encephalitis Presenting With Cerebellitis in a Pediatric Patient.

Teaching NeuroImage: Anti-NMDA Receptor Encephalitis Presenting With Cerebellitis in a Pediatric Patient.

A Case of Headache Progressing to Coma: Atypical Presentation of West Nile Virus Encephalitis (P9-2.001)

A Case of Headache Progressing to Coma: Atypical Presentation of West Nile Virus Encephalitis (P9-2.001)

Non-convulsive Status Epilepticus due to LGI-1 Encephalitis Presenting as Intermittent Confusion (P6-14.014)

Non-convulsive Status Epilepticus due to LGI-1 Encephalitis Presenting as Intermittent Confusion (P6-14.014)

Case of LGI-1 Associated Encephalitis Presenting as Isolated Asymmetric Chorea (P6-14.019)

Case of LGI-1 Associated Encephalitis Presenting as Isolated Asymmetric Chorea (P6-14.019)

Treatment of Anti-GAD65 Autoimmune Encephalitis Presenting as NORSE with Intrathecal Dexamethasone (P1-14.005)

Treatment of Anti-GAD65 Autoimmune Encephalitis Presenting as NORSE with Intrathecal Dexamethasone (P1-14.005)

Occult Lung Cancer-Associated Autoimmune Encephalitis Presenting as Acute Psychosis.

During deployment, a 52-year-old male developed acute behavioral changes. Though initially considered to have PTSD and related agitation and confusional state, his evaluation was consistent with acute encephalopathy. Magnetic resonance imaging of the brain showed T2 hyperintensities, and CSF analysis was positive for anti-N-methyl-D-aspartate receptor antibody. A nuclear protein in testis carcinoma midline carcinoma was discovered in the lung. Immunotherapy and surgical resection led to steady improvement prior to adjuvant chemotherapy. Autoimmune encephalitis due to anti-N-methyl-D-aspartate receptor antibodies is increasingly being recognized as causal of acute behavioral change.

Demographic Profile, Respiratory Presentation and Outcome Analysis of Acute Encephalitis Syndrome in a Tertiary Hospital in Bangladesh

Acute encephalitis syndrome has been a major health problem worldwide due to its high morbidity and mortality. The aim of this study was to find out the demographic profile of acute encephalitis syndrome and to determine the association of the outcome of the disease with the demographic factors and respiratory symptoms at presentation. This observational analytic cross-sectional study was conducted in the departments of Medicine, Paediatrics, and Neurology in Bangabandhu Sheikh Mujib Medical College Hospital in Bangladesh from September 2013 to August 2014. People of all ages who fulfilled the inclusion criteria of acute encephalitis syndrome were included in the study. In this study, 270 cases were diagnosed with acute encephalitis syndrome. Most cases were clustered around the age groups of 0-5 year (24.1%), 6-17 year (24.8%), and 18 -45 year (28.5%). Death was higher among the 18-45 age groups (33.3%) as well as in males (59.3%). Apart from neurological symptoms, respiratory symptoms on presentation were present in 66.9% cases with 89.6% death and this association was found statistically significant (p value &lt; 0.001, AOR 6.96, COR 5.3 with 95% CI). Influence of socio-demographic factors and delay in seeking hospital admission on adverse outcome was not statistically significant. Most cases occurred in January-February (12.6% and 11.1%) and in July (14.4%). Overall mortality was 17.8%. Encephalitis presenting with respiratory symptoms in association carries higher mortality. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):22-26

A Case of LGI1 Encephalitis Presenting with NORSE

A Case of LGI1 Encephalitis Presenting with NORSE

Leucine-rich Glioma Inactivated 1 (LGI-1) Limbic Encephalitis Presenting with Psychotic Symptoms without Seizures: A Case Report with Five-year Follow-up and Review of Literature.

Leucine-rich Glioma Inactivated 1 (LGI-1) Limbic Encephalitis Presenting with Psychotic Symptoms without Seizures: A Case Report with Five-year Follow-up and Review of Literature.

Anti-NMDA Receptor Encephalitis Presenting with Language Impairment and Bradycardia

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is known to have various clinical symptoms, but usually shows acute behavioral changes, memory deficit, speech problems and dysregulation of autonomic nervous system. Recently, it has been found that NMDA receptors perform important roles not only in central nervous system but also in peripheral organs, like control the cardiac rhythm by located in the myocardium and cardiac conduction system. The authors would like to report a case of bradycardia accompanied by anti-NMDA receptor encephalitis.

Chikungunya Encephalitis Presenting as Rhombencephalitis.

Chikungunya Encephalitis Presenting as Rhombencephalitis.

LGI1 encephalitis–Behaviors predate movements: A case series

Abstract Anti-leucine-rich, glioma-inactivated (LGI1) autoimmune encephalitis is one of the autoimmune encephalitides with a distinct movement abnormality – faciobrachial dystonic seizures (FBDS). FBDS, being the clinching sign towards a clinical diagnosis, is known to occur at disease onset, and if left untreated, can lead to disabling cognitive impairment. In this case series, we describe three cases of LGI1 encephalitis presenting with behavioral abnormalities at onset for a significant period, compelling an alternative diagnosis preceding the onset of FBDS. In addition, it highlights that imaging could be normal in the initial stages of the disease, further making the diagnosis a challenge at an initial stage.

Bickerstaff brainstem encephalitis, an uncommon presentation in a child: a case report

BackgroundThe typical clinical and radiological presentation of Bickerstaff brainstem encephalitis (BBE) has been highlighted in this case report.Case presentationBickerstaff encephalitis is a rare autoimmune inflammatory disorder and is considered a subtype of Guillain–Barré syndrome (GBS) along with Miller Fisher syndrome. The diagnosis of BBE is largely clinical, though laboratory tests and imaging can be of supportive value. We report a case of a 5-year-old child who presented with a classical clinical triad of BBE with characteristic magnetic resonance imaging (MRI) findings.ConclusionsBBE is a rare disease with very few cases being reported with typical clinical and radiological findings. Hence, we reported a typical case of BBE to make an addition to the available literature.