Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of occipital epilepsy with anti-GluRε2 antibody in cerebrospinal fluid, presenting as repeated visual disturbance and headache

Yasuko Ohe, M.D.1), Yoshihiko Nakazato, M.D., Ph.D.2), Aya Ohkuma, M.D., Ph.D.2), Naotoshi Tamura, M.D., Ph.D.2), Yukitoshi Takahashi, M.D., Ph.D.3) and Nobuo Araki, M.D., Ph.D.2)

1)Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Center
2)Department of Neurology, Faculty of Medicine, Saitama Medical University
3)National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders

A 78-year-old man was admitted to our hospital with repeated attacks of headache and visual hallucinations, which had begun 10 days before. He also displayed left hemispatial neglect and left homonymous hemianopsia during attacks. Brain magnetic resonance imaging (MRI) showed an abnormal high-intense area in the right occipital lobe on diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) weighted imaging; this lesion was demonstrated as an area of hyperperfusion on ECD-single photon emission computed tomography (SPECT) and hypoperfusion on 123I-BZ-SPECT. Electroencephalography during an attack demonstrated epileptogenic discharges in the right occipital region. Acute urinary retention due to meningoencephalitis appeared 2 weeks after onset of the first attack. Autoantibodies against glutamate receptor ε2 were detected in cerebrospinal fluid. We diagnosed the patient with occipital epilepsy due to anti-NMDA receptor antibody encephalitis. Epileptic attacks diminished and MRI and SPECT findings improved following two administrations of intravenous bolus steroid therapy.
Full Text of this Article in Japanese PDF (818K)

(CLINICA NEUROL, 51: 505|509, 2011)
key words: anti-glutamate receptor antibodies, occipital epilepsy, focal encephalitis, steroid pulse therapy

(Received: 22-Feb-11)