Anti-LGI1 antibody positive limbic encephalitis presenting hypothalamus symptoms: A case report and literature review / 吉林大学学报(医学版)

ABSTRACT

Objective: To study the clinical characteristics of eucine-rich glioma-inactivated 1 protein (LGI1) antibody positive limbic encephalitis (LE), and to provide the reference for its diagnosis and streatment. Methods: The clinical data of a patient with anti-LGI1 antibody positive LE who presented the hypothalamus symptoms was analyzed, the literature review was performed, and the diagnosis and treatment methods of the LE patients were summarized. Results: The patient showed the following symptoms 2 months before hospitalisation, such as sexual dysfunction, overeating, taciturnity, daytime hyposia, intermittent sweating, fever without inducement, hyponatremia, intermittent memory loss and faciobrachial dystonic seizure (FBDS), and the above symptoms progressively exacerbated. After hospitalization, the Mini-Mental State Examination (MMSE) score was 22; the patient could' t finish the evaluation of Montreal Cognitive Assessment Scale (MoCA); the serum anti-LGI1 antibody was positive (1 100), and the cerebrospinal fluid anti-LGI1 antibody was positive (110). The MRI results showed T1 low signal, T2, Flair high signal, DWI high signal in bilateral hippocampus, amygdala and medial temporal lobe, especially in the right side. The patient was diagnosed as anti-LGIl antibody positive LE, whose symptoms relieved rapidly after administration of immunoglobulin and steroid therapy. After 6- monthfollow-up, the patient recovered completely. Conclusion: The positive results of serum and cerebrospinal fluid anti-LGIl antibody in the patients combined with the MRI results of head can confirm the diagnosis of anti-LGIl antibody positive LE. The hypothalamus symptoms, memory loss and FBDS are improved rapidly after immunoglobulin and steroid therapy. The hypothalamic injury possibly exist in the early-stage of anti-LGIl antibody positive LE.