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Washington University Experience | NEURODEGENERATION | Anti-NMDA Receptor (Paraneoplastic) Encephalitis | 1A0 Case 1 History
Case 1 History ---- The decedent was a 68-year old Army veteran and retired truck driver with a past medical history of coronary artery disease, carotid artery stenosis, C-spine myelopathy, OSA, T2D for 5 years and a 70 pack year smoking history. His neurologic symptoms began in August 2015 and worsened in November 2015 followed by a prolonged hospitalization stay (December 2015-March 2016). He had originally noted crying spells, anxiety, attacks, profound memory issues, headache, tremors in UE, nystagmus and dysmetria, deteriorating gait and vision abnormalities (blurred, diplopia, jumping images), insomnia (1-2 hours of sleep per night), and a 10lb weight loss. Unsteady gait progressed to non-ambulatory state due to 'head-spinning'; he also became more irritable. He was said to have improved with ECT, antipsychotics, and IVIG, and received Cytoxan. He was thought to have paraneoplastic limbic encephalitis. MRI of his brain showed mild global atrophy and T2 FLAIR hyperintensity within the left caudate and putamen. PET showed asymmetrically decreased FDG uptake in left basal ganglia. MRI changes largely resolved in a repeat scan in March 2016. The patient was diagnosed with autoimmune encephalitis after finding serum antibodies to NMDA (lower titer), and high titers of Hu and CRMP5. CSF showed lymphocytic pleocytosis with no B-cell clones. A bone marrow biopsy showed no excess blasts or B-cell non-Hodgkin lymphoma (NHL). Infectious etiologies were excluded by extensive testing. Comfort care measures were initiated in late June 2016 after discussion with the family, and he passed away in early July 2016.
