No abstract

Numerous autoantibodies are implicated in the pathogenesis of autoimmune epilepsy. In the past decade, many case series reported the association of glutamic acid decarboxylase 65 (GAD 65) antibodies with epilepsy. Conjoint presence of GAD 65 antibodies with antinuclear, anti-thyroid, and anti-parietal cell antibodies has often been demonstrated. However, concomitant elevated levels of GAD 65 and P/Q voltage gated calcium channel (VGCC) antibodies is rare. We report a case of autoimmune epilepsy with conjoint GAD 65 and P/Q VGCC antibodies in the absence of malignancy. This report highlights a possible role of P/Q VGCC antibodies in the pathogenesis of autoimmune epilepsy.

Background: Spinal cord tumors are rare. Majority originate in glial cells. Ependymoma are the most common intra-medullary tumors in adults. Intra-mural hemorrhage is a rare presentation. Coagulopathy may contribute to such a presentation. Case Report: A 38-year-old male, known to have mild bleeding disorder presented with a sudden-onset neck pain. Magnetic resonance images (MRI) of the spine demonstrated an intra-medullary mass extending from C5-T1 with a cystic component that has features of sub-acute hemorrhage like fluid-fluid level sign. The patient underwent C5-T1 laminectomy, midline myelotomy, and microscopic total resection of the spinal classical ependymoma with intra-mural hemorrhage. Hematological investigation suggested the diagnosis of low von Willebrand factor (VWF). Conclusion: This is a rare case of an intra-medullary ependymoma that presented with intra-mural hemorrhage.