Anti-NMDAR encephalitis preceded by dura mater lesions

Suzuki, Hidekazu; Kitada, Mari; Ueno, Shu‐ichi; Tanaka, Keiko; Kusunoki, Susumu

doi:10.1007/s10072-012-1169-8

Cited by 8 publications

(10 citation statements)

References 5 publications

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“…Irani et al speculated that the dura mater lacking the blood-brain barrier may be one of the first sites of inflammation in anti-NMDAR encephalitis through clinical observation of disease progression [12]. Suzuki et al reported a case of anti-NMDAR encephalitis preceded by dura mater lesions and predicted that the dura mater lesions on MRI may be available diagnosis and give insight into the the etiology and pathogenesis of anti-NMDAR encephalitis [13]. In our experience, it is unclear whether dural hypertrophy was a manifestation of anti-NMDAR encephalitis or merely coincidental.…”

Section: Discussionmentioning

confidence: 99%

Anti-NMDAR encephalitis with simultaneous hypertrophic pachymeningitis in a 68-year-old male: a rare case report

Jia

Xie

et al. 2019

BMC Neurol

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Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most frequent types of autoimmune encephalitis. However, the instigating mechanisms are as yet not fully ascertained. Cardinal clinical manifestations of anti-NMDAR encephalitis include acute behavioural change, psychosis, and catatonia. As the level of diagnosis increases, encephalitis becomes more common, but there are never been published in patients with anti-NMDAR encephalitis and simultaneous hypertrophic pachymeningitis. Case presentation A sixty-eight-year-old man who presented with mental, behavioral abnormalities, unstable walking, headaches, and erratic hand movements. The neuropsychiatric symptoms and cerebrospinal fluid examination was consistent with the diagnosis criteria of anti-NMDAR encephalitis. Magnetic resonance imaging of the brain showed a thickening of dura mater localized at the left tentorium cerebelli, left cerebral hemisphere, and cerebral falx; the thickening dura mater was characterized by an intense contrast enhancement after the administration of gadolinium. High doses of intravenous methylprednisolone were administrated during his hospitalization. After 5 days, the patient’s condition improved. Conclusions We herein describe a rare case of a 68-year-old man with anti-NMDAR encephalitis presenting with concomitant hypertrophic pachymeningitis. We systematically expounded anti-NMDAR encephalitis and hypertrophic pachymeningitis, and made bold conjectures on the etiology and pathogenesis of these two diseases, hoping to stimulate new ideas from clinicians and basic medical researchers.

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Section: Discussionmentioning

confidence: 99%

Anti-NMDAR encephalitis with simultaneous hypertrophic pachymeningitis in a 68-year-old male: a rare case report

Jia

Xie

et al. 2019

BMC Neurol

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“…The lesions can be non-enhancing, as in our case, or accompanied by subtle contrast enhancement in the affected areas or the meninges. 16 To the best of our knowledge, only one case of proton MR spectroscopic evaluation has previously been reported. 14 In the cited study, 14 spectroscopy, acquired with the single-slice multi-voxel chemicalshift technique (TE ¼ 30 and 135 ms), showed a reduced NAA peak and a slightly increased Cho peak, resulting in an inverted Cho/NAA ratio, as in our case.…”

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confidence: 98%

“…9 Despite the severity of symptoms, conventional MRI of the brain is frequently normal, often referred to as the clinical-radiologic paradox: 9 only 35% of the patients have abnormal brain MRI at disease onset, increasing to 50/55% when the entire course of the disease is considered. 10,11 When abnormal, MRI usually reveals mild and non-specific changes, 16,17 such as discrete lesions that are predominantly subtle 9 may be single or multiple, 10 and correlate poorly with symptoms. 9,10 The abnormalities identified on routine MRI studies are preferentially seen on FLAIR or T2W images, usually involving the limbic system, 14 cortical and subcortical regions of the brain (especially medial temporal lobes and frontobasal-insular regions), 5,11 followed by brainstem and basal ganglion, 9,10 and, infrequently, the spinal cord and cerebellum, 6 as in our patient.…”

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confidence: 99%

“…The main priority in managing patients with suspected encephalitis is to rule out infectious causes, many of which are effectively treated using antimicrobial agents. 16 An important differential diagnosis that should be kept in mind and excluded in a younger population with a rapid onset of cognitive and behavioural abnormalities is herpes encephalitis, which accounts for approximately 19% of encephalitis. 17 However, herpes encephalitis frequently involves temporal lobes, presents diffusion restriction on DWI/ ADC sequences and shows patchy enhancement on contrast-enhanced images.…”

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confidence: 99%

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Magnetic resonance imaging and magnetic resonance spectroscopy in a young male patient with anti-N-methyl-D-aspartate receptor encephalitis and uncommon cerebellar involvement: A case report with review of the literature

et al. 2015

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We report a case of a 17-year-old man presenting with new onset psychiatric symptoms. Magnetic resonance imaging (MRI) and proton magnetic resonance (MR) spectroscopy revealed some lesions in the right cerebellar hemisphere and ipsilateral cerebellar tonsil suggestive of encephalitis. An extensive workup was negative for both infectious and neoplastic diseases and he was afterward diagnosed with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. This disorder is an autoimmune encephalitis, highly lethal but curable, predominantly found in young female with ovarian teratoma. He received methylprednisolone. His clinical findings gradually improve and he made a complete recovery. Accordingly, repeated brain MRI and proton MR spectroscopy showed a gradual reduction of the lesions; MRI taken six months after starting therapy showed complete resolution of the lesions. Our case shows that, although rare, anti-NMDAR encephalitis should be considered also in young men for whom a rapid onset of psychiatric neurological disorders cannot be explained by more frequent causes. Our report underlines also the usefulness of MRI and proton MR spectroscopic findings in the diagnosis and follow-up of this disease.

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“…In addition to ovarian teratomas, many cases show that other tumors may trigger the anti-NMDAR immune response. Hepatic neuroendocrine carcinoma is associated with this disorder [20]; anti-NMDAR encephalitis is associated with a large-cell neuroendocrine carcinoma [21]; anti-NMDAR encephalitis may be related to matter lesions [22,23]; an 18 year old female case was caused by a large mature mediastinal teratoma [24]; a right anterior mediastinal mass with no adenopathy was found in a female patient [25]; an anti-NMDAR encephalitis male patient had a testicular teratoma and seminoma [26]; a case report showed the association between anti-NMDAR encephalitis and small cell lung carcinoma [27]. More references to the associations between this disease and tumors are listed in Table 1.…”

Section: Introductionmentioning

confidence: 99%

Phylogenetic Analysis to Explore the Association Between Anti-NMDA Receptor Encephalitis and Tumors Based on microRNA Biomarkers

Wang

2019

Biomolecules

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MicroRNA (miRNA) is a small non-coding RNA that functions in the epigenetics control of gene expression, which can be used as a useful biomarker for diseases. Anti-NMDA receptor (anti-NMDAR) encephalitis is an acute autoimmune disorder. Some patients have been found to have tumors, specifically teratomas. This disease occurs more often in females than in males. Most of them have a significant recovery after tumor resection, which shows that the tumor may induce anti-NMDAR encephalitis. In this study, I review microRNA (miRNA) biomarkers that are associated with anti-NMDAR encephalitis and related tumors, respectively. To the best of my knowledge, there has not been any research in the literature investigating the relationship between anti-NMDAR encephalitis and tumors through their miRNA biomarkers. I adopt a phylogenetic analysis to plot the phylogenetic trees of their miRNA biomarkers. From the analyzed results, it may be concluded that (i) there is a relationship between these tumors and anti-NMDAR encephalitis, and (ii) this disease occurs more often in females than in males. This sheds light on this issue through miRNA intervention.

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Anti-NMDAR encephalitis preceded by dura mater lesions

Cited by 8 publications

References 5 publications

Anti-NMDAR encephalitis with simultaneous hypertrophic pachymeningitis in a 68-year-old male: a rare case report

Anti-NMDAR encephalitis with simultaneous hypertrophic pachymeningitis in a 68-year-old male: a rare case report

Magnetic resonance imaging and magnetic resonance spectroscopy in a young male patient with anti-N-methyl-D-aspartate receptor encephalitis and uncommon cerebellar involvement: A case report with review of the literature

Phylogenetic Analysis to Explore the Association Between Anti-NMDA Receptor Encephalitis and Tumors Based on microRNA Biomarkers

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