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Isolated Memory Loss in Anti-NMDAR Encephalitis
Raffaele Iorio1, Eleonora Sabatelli2, Lucia Campetella2
1From the UOC Neurologia (R.I.), Fondazione Policlinico Universitario A. Gemelli IRCCS; and Università Cattolica del Sacro Cuore (R.I., E.S., L.C., C.P.), Rome, Italy. raffaele.iorio@policlinicogemelli.it.
Background And Objectives:
To report a case of anti-NMDAR encephalitis presenting with isolated memory dysfunction.
Methods:
A 29-year-old woman was admitted to the Neurology Department referring memory impairment with a subacute onset. The initial assessment included EEG, neuropsychological tests, and brain MRI. Serum and CSF samples were collected for immunologic studies. The diagnostic evaluation was completed with a total body PET scan.
Results:
Patient's neurologic examination was unremarkable apart from an episodic memory deficit, confirmed by neuropsychological examination. The EEG revealed epileptiform discharges in the temporal lobes, whereas brain MRI showed bilateral temporal lobes hyperintense lesions on fluid-attenuated inversion recovery images and T2-weighted images. NMDAR-IgG was detected in the patient's serum and CSF by cell-based assay confirming the diagnosis of definite anti-NMDAR encephalitis. The total body PET showed only a slight hypometabolism in the right temporal cortex and in the cerebellar hemispheres. After a course of IV immunoglobulin and corticosteroid therapy, a marked improvement of the memory deficit was observed.
Discussion:
This case shows that anti-NMDAR encephalitis can present with isolated memory loss. Neural antibody testing in these patients could play a pivotal role in early diagnosis and prompt treatment.
Insights
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis can manifest as isolated memory loss. Early neural antibody testing is crucial for diagnosing and treating this condition effectively.
Area of Science:
- Neurology
- Immunology
- Neuroscience
Background:
- Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neurological disorder.
- It is often associated with psychiatric symptoms, seizures, and movement disorders.
Observation:
- A 29-year-old woman presented with subacute onset of isolated memory impairment.
- Neurological examination was unremarkable except for episodic memory deficit.
- EEG showed temporal lobe epileptiform discharges, and MRI revealed bilateral temporal lobe hyperintensities.
Findings:
- NMDAR-IgG antibodies were detected in serum and cerebrospinal fluid (CSF).
- Diagnosis of anti-NMDAR encephalitis was confirmed via cell-based assay.
- Treatment with IV immunoglobulin and corticosteroids led to significant memory improvement.
Implications:
- This case highlights that anti-NMDAR encephalitis can present solely with memory dysfunction.
- Prompt neural antibody testing is vital for early diagnosis and effective management.
- Early intervention can lead to marked improvement in cognitive deficits.
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