Meningioma preceding CASPR2 antibody limbic encephalitis with a stroke mimic: A case report.

Medicine
Xiao-Jin LuBao-Lin Shi

Abstract

Todd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room. We report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE. CASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE. The patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days). Remission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 day...Continue Reading

References

Sep 25, 2010·Journal of Neurology·H KearneyT Lynch
Feb 18, 2012·Journal of Neurology, Neurosurgery, and Psychiatry·Esther B E BeckerAngela Vincent
May 19, 2012·BMJ Case Reports·Patricia SimalJose Antonio Egido
Jan 7, 2017·Journal of Neurosurgery·Martin PiazzaPrashant Chittiboina
Nov 14, 2018·Journal of Neurology·Annette BaumgartnerOliver Stich

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