and 1 other(s)
Background and aim Limbic encephalitis represents a group of autoimmune conditions, and its key symptoms are a severe impairment of short-term memory, seizure and psychiatric symptoms, as psychosis and mania. We describe clinical symptomatology, diagnosis and management of limbic encephalitis in a patient, initially presenting with symptoms of mania and delusional disorder. Methods This is a case study of limbic encephalitis in 53-year old gentleman with no previous neuropsychiatric history; admitted to the psychiatric intensive care unit on 10th September 2017 following a subacute deterioration of his mental health; physically aggressive, elevated in mood, paranoid-persecutory and grandiose delusions. No cognitive deficit, no neurological symptoms. Psychosis effectively manged with zuclopenthixol deaconate due no non-compliance with oral medication, and on 25th October transferred to acute psychiatric ward with diagnosis of persistent delusional disorder. On 10th November 2017, he had a four-minute grand mal seizure. On further assessment, cognitive decline, and severe short-term memory noted; Addenbrooke’s Cognitive Examination: 55/100. Results Normal ECG, neutrophilia 9.14 x109, ALT 65 umol/l, GGT -83 umol/l, Prolactin 388 mIU/l, and Vitamin B12-184 ng/l. CT head (14th September, and 8th November 2018): normal. EEG and lumbar punction (November 2017): normal. MRI head (21st November 2017): bilateral high signal around the temporal horn, and diffusion abnormality, suggestive of encephalitis. PCR and Anti- NMDAR antibodies: negative. Anti-VGKC: positive. Patient was treated with levitiracetam and prednisolone. Conclusion It is important to consider the possibility of anti-VGKC encephalitis in all patients with new-onset psychosis or mania. Red flags include neurologic symptoms such as facial twitching, seizures, confusion, and cognitive decline.
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