Anti-Ma encephalitis masquerading as Wernicke encephalopathy

Area of Science:

• Neurology
• Oncology
• Immunology

Background:

• Anti-Ma encephalitis is typically linked to testicular cancer in young males.
• Gastric cancer association with Anti-Ma encephalitis presenting as Wernicke encephalopathy-like symptoms is uncommon.
• This report details a rare case in an elderly patient initially misdiagnosed.

Observation:

• A 71-year-old male with alcohol abuse presented with dizziness, diplopia, and anorexia.
• Initial Wernicke encephalopathy diagnosis and Vitamin B1 treatment were ineffective.
• Detection of anti-Ma1/2 antibodies in blood and CSF confirmed the diagnosis.

Findings:

• ¹⁸F-FDG PET-MR revealed hypermetabolic changes in the hypothalamus, basal ganglia, and brainstem.
• Gastric neoplasms with liver metastasis were identified.
• The patient was diagnosed with Anti-Ma encephalitis.

Implications:

• Anti-Ma encephalitis should be considered in patients with Wernicke encephalopathy-like symptoms unresponsive to Vitamin B1.
• This case highlights the importance of antibody testing for accurate diagnosis.
• Timely diagnosis and treatment are crucial for managing this rare autoimmune encephalitis.