Ophthalmoplegia and Flaccid Paraplegia in a Patient with Anti-NMDA Receptor Encephalitis: A Case Report and Literature Review
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- Ishikawa Yuichi
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Ikeda Ken
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Murata Kiyoko
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Hirayama Takehisa
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Takazawa Takanori
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Yanagihashi Masaru
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Kano Osamu
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Kawabe Kiyokazu
- Department of Neurology, Toho University Omori Medical Center, Japan
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- Takahashi Yukitoshi
- Department of Pediatrics, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
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- Iwasaki Yasuo
- Department of Neurology, Toho University Omori Medical Center, Japan
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Abstract
We herein report the case of a 26-year-old woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis presenting with ophthalmoplegia and flaccid paraplegia. She developed disorientation and hallucination after fever and vomiting. Hypothermia, hypoventilation, hypertension, paralytic ileus and hyponatremia were present. Neurological examination showed mild consciousness disturbance and bilateral ophthalmoplegia on admission, flaccid paraplegia with leg areflexia on Day 4. Anti-NMDAR antibodies were detected in the serum and cerebrospinal fluid samples. Motor nerve conduction velocity was decreased in the tibial and peroneal nerves. F-wave amplitudes were reduced in the tibial nerve. MRI disclosed lesions in the callosal splenium, hippocampus and cerebral subarachnoid regions. In addition to various encephalitic symptoms, physicians should pay more attention to peripheral nerve damage in patients with anti-NMDAR encephalitis.<br>
Journal
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- Internal Medicine
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Internal Medicine 52 (24), 2811-2815, 2013
The Japanese Society of Internal Medicine
