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Delta brush on EEG: a characteristic EEG finding in autoimmune encephalitis
Shafaq Saleem1, Sarwar Jamil Siddiqui2, Faizan Abdullah Qureshi3
1Neurology, The Aga Khan University Hospital, Main Campus Karachi, Karachi, Sindh, Pakistan drshafaqsaleem@gmail.com.
BMJ Case Reports
|February 10, 2023
Summary
Anti-NMDA receptor encephalitis, an autoimmune disorder, can cause acute behavioral changes. Early diagnosis using EEG delta brush patterns and immunotherapy improves patient outcomes and cognitive function.
Area of Science:
- Neurology
- Immunology
- Psychiatry
Background:
- Autoimmune encephalitis is a severe neurological disorder.
- N-methyl-D-aspartate (NMDA) receptor encephalitis predominantly affects women of childbearing age.
- Acute-onset behavioral changes and suicidal ideation can indicate serious underlying pathology.
Observation:
- A young woman presented with acute behavioral changes and suicidal thoughts.
- Cerebrospinal fluid analysis revealed positive N-methyl-D-aspartate receptor antibodies.
- Electroencephalogram (EEG) demonstrated a characteristic delta brush pattern in the bilateral frontal regions.
Findings:
- The delta brush pattern on EEG is a specific diagnostic marker for NMDA receptor encephalitis.
- The patient showed a positive response to immunotherapy with intravenous methylprednisolone and oral steroids.
- Further workup for teratoma or mediastinal tumors was recommended, common in NMDA receptor encephalitis.
Implications:
- Early identification of NMDA receptor encephalitis through specific EEG findings is crucial.
- Prompt immunotherapy significantly improves survival rates and reduces the risk of cognitive impairment.
- Investigating mental deterioration for underlying pathological causes like autoimmune encephalitis is essential for timely intervention.
