Journal
INTERNAL MEDICINE
Volume 58, Issue 19, Pages 2861-2864Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.2805-19
Keywords
anti-NMDAR encephalitis; orthostatic hypotension; arginine vasopressin; magnetic resonance imaging; brainstem auditory-evoked potentials; blink reflex
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After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis.
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