Immunotherapy-responsive limbic encephalitis with antibodies to glutamic acid decarboxylase.

Glutamic acid decarboxylase (GAD) has been recently identified as a target of humoral autoimmunity in a small subgroup of patients with non-paraneoplastic limbic encephalitis (NPLE). We present a patient with NPLE and positive anti-GAD antibodies who showed significant improvement after long-term immunotherapy. A 48-year old female was admitted with a two-year history of anterograde amnesia and seizures. Brain MRI revealed bilateral lesions of medial temporal lobes. Screening for anti-neuronal antibodies showed high anti-GAD titers in both serum and cerebrospinal fluid (CSF) with strong evidence of intrathecal production. The patient received treatment with prednisolone and long-term plasma exchange. During a 12-month follow-up, she exhibited complete seizure remission and an improvement in memory and visuo-spatial skills. Anti-GAD antibodies may serve as a useful marker to identify a subset of NPLE patients that respond to immunoregulatory treatment.

Unilateral lumbosacral dislocation: case report and a comprehensive review.

Lumbosacral fracture-dislocation is a rare occurrence. There are more than 73 cases reported in the English literature. We report on the imaging findings and surgical treatment in a patient suffered of unilateral traumatic L5-S1 dislocation associated with severe disruption of the posterior ligamentous complex. The patient underwent open reduction and stabilization of L4-S1 vertebrae with posterior instrumentation system. Open reduction and internal fixation was mandatory as post-traumatic ligamentous insufficiency would lead to abnormal motion. Operative treatment managed to produce a solid arthrodesis and restore stability of the lumbosacral junction. Follow-up revealed excellent results. This study reports a rare injury of the lumbosacral junction, and the literature concerning this unusual condition is extensively reviewed.