Department of Psychiatry, Medical University of Bialystok, Bialystok, Poland.
Department of Neurology, Medical University of Bialystok, Bialystok, Poland.
Front Immunol. 2024 Aug 29;15:1416019. doi: 10.3389/fimmu.2024.1416019. eCollection 2024.
We present the case of a 35-year-old female patient admitted to the hospital with symptoms of rapidly increasing disturbances of consciousness and fever for 48 hours. A lumbar puncture, bacteriological and virological examinations, and initial imaging studies did not show abnormalities. Brain magnetic resonance imaging (MRI), repeated several times, showed hyperintense confluent lesions in both temporal lobes and atrophy of both hippocampi. General examination, cerebrospinal fluid culture, the panel of antineuronal antibodies, and tumor markers remained negative on subsequent repeats. Despite several laboratory and imaging studies, the etiology of the disease could not be established, infections were excluded, and no autoantibodies were found. A diagnosis of probable limbic encephalitis, amnestic syndrome resulting from organic brain damage, and drug-resistant epilepsy was made. The patient, with limbic encephalitis complicated by drug-resistant status epilepticus, was treated with cycles of immunoglobulin and subsequent plasmapheresis. She was then transferred to the Department of Psychiatry for diagnosis and treatment of intermittent psychotic disorders. During hospitalization, the patient was observed to have multiple epileptic seizures with temporal and frontal morphology, amnestic syndrome with confabulations, and periodic psychotic disorders with the occurrence of visual hallucinations. Antiepileptic treatment was escalated by including cenobamate in increasing doses. To control the mental disorders, duloxetine, tiapride, and cognitive function exercises were introduced. There was a slight improvement in memory, a cessation of confabulations, and an emergence of the patient's criticism of the symptoms presented. The psychotic symptoms subsided, and the number of epileptic seizures decreased. The described case portrays a unique co-occurrence of disease symptoms that are difficult to treat. It shows the therapeutic difficulties that can occur in patients with suspected autoimmune encephalitis. Furthermore, it shows the need for multispecialty care of a patient with psychotic symptoms in the course of epilepsy accompanied by amnestic syndrome.
我们报告了一例 35 岁女性患者，因意识迅速障碍和发热 48 小时入院。腰椎穿刺、细菌学和病毒学检查以及初步影像学研究均未见异常。脑磁共振成像（MRI）多次重复显示双侧颞叶高信号融合病变和双侧海马萎缩。随后的重复检查均未见一般检查、脑脊液培养、神经元抗体谱和肿瘤标志物异常。尽管进行了多次实验室和影像学研究，仍未能确定病因，感染被排除，也未发现自身抗体。诊断为可能的边缘性脑炎，有机脑损伤导致的遗忘综合征和耐药性癫痫。该患者因边缘性脑炎合并耐药性癫痫持续状态，接受了免疫球蛋白和随后的血浆置换治疗。随后转至精神科诊断和治疗间歇性精神病障碍。住院期间，患者观察到有颞叶和额叶形态的多次癫痫发作、伴有虚构的遗忘综合征和伴有视觉幻觉的间歇性精神病障碍。通过增加剂量包括佐尼莫特来升级抗癫痫治疗。为了控制精神障碍，引入了度洛西汀、硫必利和认知功能锻炼。记忆力略有改善，虚构停止，患者对所呈现的症状开始批评。精神病症状缓解，癫痫发作次数减少。该病例描述了一种疾病症状难以治疗的独特共存，表明了疑似自身免疫性脑炎患者可能出现的治疗困难。此外，它还表明了在伴有遗忘综合征的癫痫发作过程中，需要对伴有精神病症状的患者进行多学科治疗。
