Emilija Šlajūtė1, Greta Pšemeneckienė1,2
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Department of Neurology, Kaunas, Lithuania
Abstract
Background. Autoimmune limbic encephalitis is an antibody-mediated inflammatory disease affecting the CNS, characterized by short-term memory impairment, epileptic seizures, and psychiatric symptoms—manifestations common to a broad spectrum of diseases. Despite established diagnostic criteria, the differential diagnosis of limbic encephalitis is challenging.
Case report. A 41-year-old woman, previously experiencing a fever, developed an epileptic seizure, followed by impaired consciousness, behavior, and memory. Blood, urine, and CSF analysis revealed no significant changes. COVID-19 infection, chronic CNS infections, and psychoactive substance use were excluded. Brain MRI suggested limbic encephalitis, prompting an Autoimmune Encephalitis Panel evaluation. Given the history of alcohol abuse, Wernicke’s encephalopathy remained a consideration, leading to the treatment with thiamine and antipsychotics. All symptoms except memory impairment resolved. Further assessment for persistent memory issues identified neuropsychological and radiological uncus pathology features. Subsequent analyses of CSF and the CSF Autoimmune Encephalitis Panel showed no abnormalities. However, Anti-Yo and Anti-Recoverin onconeuronal antibodies, which were not specific to the patient’s condition, were identified in the blood serum in the absence of oncology. After the exclusion of other causes, limbic encephalitis was set as the most likely diagnosis, which resulted in the administration of methylprednisolone and cognitive function restoration.
Conclusions. The presence of overlapping symptoms in limbic encephalitis and the identification of numerous potential causes of condition complicate its differential diagnosis. It is essential to approach the assessment of the patient’s comorbidities and lifestyle factors with caution, recognizing that they may not directly cause the observed condition.
Keywords: autoimmune encephalitis, paraneoplastic syndromes, anti-Yo antibodies, Wernicke encephalopathy.