Leucine-rich glioma-inactivated protein 1 (LGI-1) mediated limbic encephalitis associated with syndrome of inappropriate antidiuretic hormone secretion: a case report. Issue 1 (31st January 2020)

• Record Type: Journal Article
• Authors: Whiles, Emily; Joshi, Hareesh; Prachi, Prachi; Kavuri, Venkaiah; Sagi, Satyanarayana V
• Is Part Of: Oxford medical case reports. Volume 2020:Issue 1(2020)
• Publication Date: 2020-01-31
• Subjects: autoimmune encephalitis -- LGI-1 -- hyponatraemia -- SIADH -- seizures; Clinical medicine -- Case studies -- Periodicals; 616.09
• DOI: 10.1093/omcr/omz136
• Languages: English
• ISSNs: 2053-8855

Abstract

Abstract: Autoantibodies to leucine-rich glioma-inactivated protein 1 (LGI-1) are associated with inflammation of the limbic system. Faciobrachial dystonic seizures are pathognomonic for LGI1-antibiodies and their treatment with immunotherapy is effective in seizure control with a potential to prevent cognitive decline. We report a 57-year-old man who presented to the emergency department with recurrent seizures, visual hallucinations and severe memory impairment over a seven-week period; he reported a background of alcohol excess. Initial investigations revealed hyponatremia, indicating syndrome of inappropriate anti-diuretic hormone secretion. Magnetic resonance imaging of the brain revealed bilateral asymmetrical high-T2 and low-T1 signal in the medial temporal lobes. Serum immunofluorescence assay tested positive for LGI-1 antibody. Patient responded to treatment with levetiracetam, intravenous methylprednisolone and five plasma exchange sessions. Patient remains on a maintenance dose of prednisolone and azathioprine. It is imperative that clinicians recognize signs of autoimmune encephalitis in order to curb long-term sequelae and improve clinical outcomes.