Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Encephalitis associated with positive anti-GluR antibodies showing abnormal appearance in basal ganglia, pulvinar and gray matter on MRI-Case report

Toshio Saito, M.D.1), Tomoko Saito, M.D.1), Yukitoshi Takahashi, M.D.2), Yosuke Kokunai, M.D.3) and Harutoshi Fujimura, M.D.1)

1)Division of Neurology, National Hospital Organization Toneyama National Hospital
2)National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
3)Department of Neurology, Osaka University Graduate School of Medicine

We treated a 25-year-old woman with encephalitis. Following delivery, the patient developed fever, consciousness disturbance, cognitive dysfunction, and progressive motor dysfunction. In addition, mycobacterium tuberculosis was found in the lung, though there was no evidence of such infection in the central nervous system. Cerebrospinal fluid analysis revealed a slight elevation of mononuclear cells with a normal protein level, indicating a possible viral infection. We could not find the origin of the infection, though the serum anti-glutamate ε2 receptor antibody was positive. Intravenous administration of methylprednisolone (1,000 mg/day for 3 days) was temporarily effective for improvement of the clinical signs and symptoms. However, she finally demonstrated rapid deterioration resulting in death. Diffusion-weighted brain magnetic resonance imaging demonstrated abnormal high intensity lesions in the bilateral pulvinar and gray matter, with an abnormal appearance mimicking pulvinar sign.
Full Text of this Article in PDF (444K)

(CLINICA NEUROL, 51: 192|196, 2011)
key words: anti-glutamate receptor antibody, encephalitis, Pulvinar sign

(Received: 26-Jul-10)