Abstract Details

Title May visual neglect hide an autoimmune process?

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-094

Objective NA

Background

Diagnosis of autoimmune encephalitis (AE) might be extremely challenging due to symptoms heterogeneity and inconclusive routine diagnostic tests, such as seronegativity and non-specific MRI and electroencephalographic patterns. Aiming to facilitate early diagnosis, new consensus guidelines have been recently issued, defining criteria for possible or definite AE. Nevertheless, some atypical presentation might be still missed.

Design/Methods NA

Results A 71 years-old man referred for acute onset of blurred vision with evidence of left hemianopsia, hemispatial neglect and anosognosia at neurological and neuropsychological examination. He reported a recent bronchitis, cardiovascular risk factors and history of lobectomy for small-cell lung cancer followed by radiochemotherapy, with five-years disease-free survival. Brain MRI, electroencephalogram and immunological screening were unremarkable. Cerebrospinal fluid (CSF) analysis disclosed mild hyperproteinorrachia with 1 lymphocyte/mm3 (activated lymphocytes) and evidence of mirror pattern, while microbiological examinations (neurotropic viruses, Borrelia, HIV) were unrevealing. No alterations of tau, 14.3.3 and beta-amyloid levels were observed. Tumour markers, serum and CSF onconeural antibodies were negative and no evidence of cancer relapse was detected on whole-body 18F-fluorodeoxy-glucose PET (FDG-PET). Interestingly, brain FDG-PET revealed intense hypermetabolism of right parieto-temporal cortex, with relative hypometabolism of right frontal lobe and heterogenous distribution of radiotracer in the remaining cortex, especially at left temporal cortex. Patient was put on steroid treatment with symptoms improvement, also corroborated by a second neuropsychological evaluation. One month later, CSF analysis confirmed mirror pattern without hyperproteinorrachia, while cerebral FDG-PET showed hypometabolism of right parieto-temporal cortex and normalization of radiotracer distribution along the remaining cortex.

Conclusions Atypical presentations of AE require to carefully exclude other possible etiologies and FDG-PET confirms its role as a useful and sensitive biomarker, since it might address or even represent a turning point in the diagnosis of neurological autoimmune disorders, especially in cases with atypical presentation and seronegativity, thus leading to early treatment and better prognosis.

Authors/Disclosures
Valentina Poretto, MD (Department of Emergency, Neurology Unit) PRESENTER	Dr. Poretto has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sabrina Marangoni (Ospedale Santa Chiara)	No disclosure on file
	No disclosure on file
Bruno Giometto, MD (Azienda Provinciale Er I Servizi Sanitari)	Dr. Giometto has nothing to disclose.

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