A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis

After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundle...

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Autores principales: Murakami, Takenobu, Nakatani-Enomoto, Setsu, Enomoto, Hiroyuki, Takahashi, Yukitoshi, Ugawa, Yoshikazu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society of Internal Medicine 2019
Materias:
Case Report
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815904/
https://www.ncbi.nlm.nih.gov/pubmed/31178512
http://dx.doi.org/10.2169/internalmedicine.2805-19
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author Murakami, Takenobu
Nakatani-Enomoto, Setsu
Enomoto, Hiroyuki
Takahashi, Yukitoshi
Ugawa, Yoshikazu
author_facet Murakami, Takenobu
Nakatani-Enomoto, Setsu
Enomoto, Hiroyuki
Takahashi, Yukitoshi
Ugawa, Yoshikazu
author_sort Murakami, Takenobu
collection PubMed
description After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis.
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spelling pubmed-68159042019-10-29 A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis Murakami, Takenobu Nakatani-Enomoto, Setsu Enomoto, Hiroyuki Takahashi, Yukitoshi Ugawa, Yoshikazu Intern Med Case Report After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis. The Japanese Society of Internal Medicine 2019-06-07 2019-10-01 /pmc/articles/PMC6815904/ /pubmed/31178512 http://dx.doi.org/10.2169/internalmedicine.2805-19 Text en Copyright © 2019 by The Japanese Society of Internal Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Murakami, Takenobu
Nakatani-Enomoto, Setsu
Enomoto, Hiroyuki
Takahashi, Yukitoshi
Ugawa, Yoshikazu
A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title_full A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title_fullStr A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title_full_unstemmed A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title_short A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis
title_sort unique shape of brainstem lesion that caused orthostatic hypotension in anti-nmdar encephalitis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815904/
https://www.ncbi.nlm.nih.gov/pubmed/31178512
http://dx.doi.org/10.2169/internalmedicine.2805-19
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