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A Case of HIV Seroconversion Presenting Similarly to Anti-N-methyl-d-aspartate Receptor Encephalitis

  • Heather VanDongen-Trimmer
  • Kumar Sannagowdara
  • Binod Balakrishnan
  • Raquel Farias-MoellerEmail author
A Day in the Life of a Neurocritical Care Trainee
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Introduction

Continuous electroencephalogram (cEEG) monitoring is recommended in patients with acute supratentorial brain injury and altered mental status, such as patients with encephalitis. This practice may help facilitate prompt treatment of non-convulsive seizures and status epilepticus as well as assess the severity of encephalopathy [1]. As more critically ill patients with encephalopathy are being monitored with cEEG, experience is gained in recognizing EEG background patterns that can aid in prognostication, prediction of illness trajectory, and in a few occasions as biomarkers for specific disease processes [1].

Patients with N-methyl-d-aspartate receptor encephalitis (NMDARE) usually present with amnesia, seizures, psychiatric symptoms, dyskinesias, and autonomic dysfunction. Since the discovery of this antibody-mediated encephalitis in 2005 [2, 3], significant advances have been made in the description of the pathophysiology, clinical presentation, biomarkers, and...

Notes

Author’s Contributions

Heather VanDongen-Trimmer was involved in data collection, manuscript redaction and editing, original conceptualization of the manuscript. Binod Balakrishnan was involved in data collection, manuscript redaction and editing. Kumar Sannagowdara was involved in data collection, image identification, review and editing, manuscript redaction and editing. Raquel Farias-Moeller was involved in data collection, manuscript redaction and editing, original conceptualization of the manuscript, project supervision.

Source of Support

No external funding was received for this manuscript.

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval/Informed consent

Ethical approval was obtained by our institutional review board prior to submission and the case is devoid of personal identifying information.

References

  1. 1.
    Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32:87–95.CrossRefGoogle Scholar
  2. 2.
    Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005;58:594–604.CrossRefGoogle Scholar
  3. 3.
    Dalmau J, Tuzun E, Wu HY, et al. Paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61:25–36.CrossRefGoogle Scholar
  4. 4.
    Gordon-Lipkin E, Yeshokumar AK, Saylor D, Arenivas A, Probasco JC. Comparative outcomes in children and adults with anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis. J Child Neurol. 2017;32:930–5.CrossRefGoogle Scholar
  5. 5.
    Guasp M, Dalmau J. Encephalitis associated with antibodies against the NMDA receptor. Med Clin (Barc). 2018;151:71–9.CrossRefGoogle Scholar
  6. 6.
    Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12:157–65.CrossRefGoogle Scholar
  7. 7.
    Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79:1094–100.CrossRefGoogle Scholar
  8. 8.
    Wang J, Wang K, Wu D, Liang H, Zheng X, Luo B. Extreme delta brush guides to the diagnosis of anti-NMDAR encephalitis. J Neurol Sci. 2015;353:81–3.CrossRefGoogle Scholar
  9. 9.
    Foff EP, Taplinger D, Suski J, Lopes MB, Quigg M. EEG findings may serve as a potential biomarker for anti-NMDA receptor encephalitis. Clin EEG Neurosci. 2017;48:48–53.CrossRefGoogle Scholar
  10. 10.
    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10:63–74.CrossRefGoogle Scholar
  11. 11.
    Hinson HE, Takahashi C, Altowaijri G, Baguley IJ, Bourdette D. Anti-NMDA receptor encephalitis with paroxysmal sympathetic hyperactivity: an under-recognized association? Clin Auton Res. 2013;23:109–11.CrossRefGoogle Scholar
  12. 12.
    Liu X, Yan B, Wang R, et al. Seizure outcomes in patients with anti-NMDAR encephalitis: a follow-up study. Epilepsia. 2017;58:2104–11.CrossRefGoogle Scholar
  13. 13.
    Maneta E, Garcia G. Psychiatric manifestations of anti-NMDA receptor encephalitis: neurobiological underpinnings and differential diagnostic implications. Psychosomatics. 2014;55:37–44.CrossRefGoogle Scholar
  14. 14.
    Mohammad SS, Dale RC. EEG background activity and extreme delta brush in children with anti-NMDAR encephalitis. Eur J Paediatr Neurol. 2018;22:207–8.CrossRefGoogle Scholar
  15. 15.
    Castellano J, Glover R, Robinson J. Extreme delta brush in NMDA receptor encephalitis. Neurohospitalist. 2017;7:NP3–4.CrossRefGoogle Scholar
  16. 16.
    Armangue T, Titulaer MJ, Malaga I, et al. Pediatric anti-N-methyl-d-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients. J Pediatr. 2013;162(850–6):e2.Google Scholar
  17. 17.
    Yildirim M, Konuskan B, Yalnizoglu D, Topaloglu H, Erol I, Anlar B. Electroencephalographic findings in anti-N-methyl-d-aspartate receptor encephalitis in children: a series of 12 patients. Epilepsy Behav. 2018;78:118–23.CrossRefGoogle Scholar
  18. 18.
    Zhang Y, Liu G, Jiang MD, Li LP, Su YY. Analysis of electroencephalogram characteristics of anti-NMDA receptor encephalitis patients in China. Clin Neurophysiol. 2017;128:1227–33.CrossRefGoogle Scholar
  19. 19.
    Casciato S, Gambardella S, Mascia A, et al. Severe and rapidly-progressive Lafora disease associated with NHLRC1 mutation: a case report. Int J Neurosci. 2017;127:1150–3.CrossRefGoogle Scholar
  20. 20.
    Theroux LM, Goodkin HP, Heinan KC, Quigg M, Brenton JN. Extreme delta brush and distinctive imaging in a pediatric patient with autoimmune GFAP astrocytopathy. Mult Scler Relat Disord. 2018;26:121–3.CrossRefGoogle Scholar
  21. 21.
    Schmidt LS, Kjaer TW, Schmiegelow K, Born AP. EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement. Eur J Paediatr Neurol. 2017;21:795–7.CrossRefGoogle Scholar
  22. 22.
    Farias-Moeller R, Bartolini L, Staso K, Schreiber JM, Carpenter JL. Early ictal and interictal patterns in FIRES: the sparks before the blaze. Epilepsia. 2017;58:1340–8.CrossRefGoogle Scholar
  23. 23.
    Baykan B, Gungor Tuncer O, Vanli-Yavuz EN, et al. Delta brush pattern is not unique to NMDAR encephalitis: evaluation of two independent long-term EEG cohorts. Clin EEG Neurosci. 2018;49:278–84.CrossRefGoogle Scholar
  24. 24.
    Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.CrossRefGoogle Scholar
  25. 25.
    Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. 1998;339:33–9.CrossRefGoogle Scholar
  26. 26.
    Hogan C, Wilkins E. Neurological complications in HIV. Clin Med (Lond). 2011;11:571–5.CrossRefGoogle Scholar
  27. 27.
    Zhang J, Liu J, Katafiasz B, Fox H, Xiong H. HIV-1 gp120-induced axonal injury detected by accumulation of beta-amyloid precursor protein in adult rat corpus callosum. J Neuroimmune Pharmacol. 2011;6:650–7.CrossRefGoogle Scholar
  28. 28.
    Hoefer MM, Sanchez AB, Maung R, et al. Combination of methamphetamine and HIV-1 gp120 causes distinct long-term alterations of behavior, gene expression, and injury in the central nervous system. Exp Neurol. 2015;263:221–34.CrossRefGoogle Scholar
  29. 29.
    Kaul M, Garden GA, Lipton SA. Pathways to neuronal injury and apoptosis in HIV-associated dementia. Nature. 2001;410:988–94.CrossRefGoogle Scholar
  30. 30.
    Zhou Y, Liu J, Xiong H. HIV-1 glycoprotein 120 enhancement of N-methyl-d-aspartate NMDA receptor-mediated excitatory postsynaptic currents: implications for HIV-1-associated neural injury. J Neuroimmune Pharmacol. 2017;12:314–26.CrossRefGoogle Scholar
  31. 31.
    O’Donnell LA, Agrawal A, Jordan-Sciutto KL, Dichter MA, Lynch DR, Kolson DL. Human immunodeficiency virus (HIV)-induced neurotoxicity: roles for the NMDA receptor subtypes. J Neurosci. 2006;26:981–90.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Division of Child Neurology, Department of NeurologyChildren’s Hospital of Wisconsin, Medical College of WisconsinMilwaukeeUSA
  2. 2.Division of Pediatric Critical Care Medicine, Department of PediatricsChildren’s Hospital of Wisconsin, Medical College of WisconsinMilwaukeeUSA

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