Antiglutamate acid decarboxylase seropositive brain stem encephalitis
Faye AlAbdulghafoor1, Raed Behbehani2, Abbas Johar3
1Neurology, King's College London, London, UK f_abdulghafour@icloud.com.
BMJ Case Reports
|March 10, 2023
Summary
A previously healthy woman developed brainstem encephalitis due to high antiglutamic acid decarboxylase (anti-GAD) antibody levels. Treatment with immunotherapy provided mild improvement, highlighting GAD antibodies in neurological disorders.
Area of Science:
- Neuroimmunology
- Neurology
- Encephalitis
Background:
- Brainstem encephalitis can present with diverse neurological deficits.
- Autoimmune etiologies are increasingly recognized in unexplained neurological conditions.
Observation:
- A middle-aged female presented with subacute horizontal gaze restriction and lower motor facial palsy.
- Cerebrospinal fluid showed albuminocytological dissociation, with a negative initial autoimmune panel.
- MRI revealed a lesion in the dorsal medial pons.
Findings:
- Elevated serum antiglutamic acid decarboxylase (anti-GAD) antibody levels confirmed the diagnosis.
- The patient received intravenous immunoglobulin and methylprednisolone, resulting in mild clinical improvement.
Implications:
- This case underscores the importance of testing for anti-GAD antibodies in suspected autoimmune brainstem encephalitis.
- Early diagnosis and immunotherapy may lead to better outcomes in GAD-seropositive encephalitis.
- Understanding the role of GAD antibodies contributes to the broader field of autoimmune neurological diseases.
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