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Extreme delta brush guides to the diagnosis of anti-NMDAR encephalitis.
J Neurol Sci. 2015; 353(1-2):81-3.JN

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable but often misdiagnosed autoimmune encephalitis. Diagnosis depends on NMDAR antibody testing, which may not be readily available. Alternatively, the electroencephalogram (EEG) extreme delta brush pattern may provide a valuable immediate indicator for the diagnosis of anti-NMDAR encephalitis. A 32-year-old female (case 1) presented with fever, headache, behavioral changes, confusion, intractable seizures, central hypoventilation, dysautonomia, facial and limb dyskinesias, and comorbid ovarian teratoma. Cerebral spinal fluid (CSF) testing revealed mild lymphocytic pleocytosis while brain MRI results were normal. A 45-year-old male (case 2) presented with major behavioral changes and rare seizures. Results of routine CSF testing and brain MRI scanning were unremarkable. In both cases, EEG initially revealed the extreme delta brush (EDB) pattern of beta bursting on the peaks and/or the troughs of delta waves, which led to subsequent NMDAR antibody testing and the confirmative diagnosis. Thus, EDB may be a readily accessible sign for suspected anti-NMDAR encephalitis.

Authors+Show Affiliations

Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: fcwangk@163.com.Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: luobenyan@zju.edu.cn.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25921549

Citation

Wang, Jianwen, et al. "Extreme Delta Brush Guides to the Diagnosis of anti-NMDAR Encephalitis." Journal of the Neurological Sciences, vol. 353, no. 1-2, 2015, pp. 81-3.
Wang J, Wang K, Wu D, et al. Extreme delta brush guides to the diagnosis of anti-NMDAR encephalitis. J Neurol Sci. 2015;353(1-2):81-3.
Wang, J., Wang, K., Wu, D., Liang, H., Zheng, X., & Luo, B. (2015). Extreme delta brush guides to the diagnosis of anti-NMDAR encephalitis. Journal of the Neurological Sciences, 353(1-2), 81-3. https://doi.org/10.1016/j.jns.2015.04.009
Wang J, et al. Extreme Delta Brush Guides to the Diagnosis of anti-NMDAR Encephalitis. J Neurol Sci. 2015;353(1-2):81-3. PubMed PMID: 25921549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extreme delta brush guides to the diagnosis of anti-NMDAR encephalitis. AU - Wang,Jianwen, AU - Wang,Kang, AU - Wu,Dengchang, AU - Liang,Hui, AU - Zheng,Xuning, AU - Luo,Benyan, Y1 - 2015/04/15/ PY - 2014/11/09/received PY - 2015/04/05/revised PY - 2015/04/06/accepted PY - 2015/4/30/entrez PY - 2015/4/30/pubmed PY - 2016/2/4/medline KW - Anti-NMDAR antibody KW - Anti-NMDAR encephalitis KW - Autoimmune encephalitis KW - Electroencephalogram KW - Extreme delta brush KW - Teratoma SP - 81 EP - 3 JF - Journal of the neurological sciences JO - J. Neurol. Sci. VL - 353 IS - 1-2 N2 - Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable but often misdiagnosed autoimmune encephalitis. Diagnosis depends on NMDAR antibody testing, which may not be readily available. Alternatively, the electroencephalogram (EEG) extreme delta brush pattern may provide a valuable immediate indicator for the diagnosis of anti-NMDAR encephalitis. A 32-year-old female (case 1) presented with fever, headache, behavioral changes, confusion, intractable seizures, central hypoventilation, dysautonomia, facial and limb dyskinesias, and comorbid ovarian teratoma. Cerebral spinal fluid (CSF) testing revealed mild lymphocytic pleocytosis while brain MRI results were normal. A 45-year-old male (case 2) presented with major behavioral changes and rare seizures. Results of routine CSF testing and brain MRI scanning were unremarkable. In both cases, EEG initially revealed the extreme delta brush (EDB) pattern of beta bursting on the peaks and/or the troughs of delta waves, which led to subsequent NMDAR antibody testing and the confirmative diagnosis. Thus, EDB may be a readily accessible sign for suspected anti-NMDAR encephalitis. SN - 1878-5883 UR - https://www.unboundmedicine.com/medline/citation/25921549/Extreme_delta_brush_guides_to_the_diagnosis_of_anti_NMDAR_encephalitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-510X(15)00206-3 DB - PRIME DP - Unbound Medicine ER -