Anti-N-methyl-D-aspartate Receptor Encephalitis in Illicit Substance Use

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disease mediated by autoantibodies against the NMDAR, typically presenting with psychiatric symptoms, cognitive dysfunction, and motor dysfunction. These neuropsychiatric symptoms may be mimicked by drug abuse, and the development of anti-NMDAR encephalitis may be triggered by certain substance use. Here we report a case of anti-NMDAR encephalitis who developed neuropsychiatric symptoms after illicit substance use, the first report in Korea.

Congestive myelopathy due to spinal dural arteriovenous fistula mimicking CNS demyelinating disease

Spinal dural arteriovenous fistula (SDAVF) is known for its ambiguous and various clinical presentations. Among these presentations, congestive myelopathy is one of the most common, yet it is challenging to correctly diagnose SDAVF at initial presentation. Several diseases present as myelopathy, including demyelinating diseases. Herein, we present two cases of congestive myelopathy due to SDAVF presenting to the emergency room (ER) with progressive quadriparesis. Even though the patients had a proper magnetic resonance imaging (MRI) examination from the initial presentation, there was a delay in making a final diagnosis. Both patients’ clinical presentation and MRI mimicked central nervous system (CNS) demyelinating disease initially, and a more thorough examination revealed SDAVF. Such a delay in diagnosis can result in more neurological deterioration and may result in more sequelae. Hence, SDAVF should always be considered as a differential diagnosis when examining patients with myelopathy.

Amphiphilic Myopathy Induced by Hydroxychloroquine Presenting with Dysarthria / 대한신경근육질환학회지

Chloroquine and hydroxychloroquine (HCQ) are commonly used antimalarial agents as the treatment for a wide range of autoimmune disorders including dermatological, rheumatoid, and connective tissue diseases. These amphiphilic drugs can cause toxic myopathy in in patients which are commonly characterized as reversible proximal muscle weakness, dysphagia and dyspnea. Herein, we report a case of a patient on HCQ, who suffered from toxic myopathy presenting as proximal muscle weakness and dysarthria, which was fully recovered after the cessation.