RESUMO
Background: To date, only a few reports of anti-LGI1 encephalitis with isolated psychiatric symptoms in the initial phase have been reported. We present a relatively rare case of antileucine-rich glioma-inactivated 1 (LGI1) encephalitis that developed only psychiatric symptoms at the onset. Case Presentation: The patient was a male in his 40s who developed anxiety and panic symptoms and was started on antidepressants after being diagnosed with panic disorder by a psychiatrist. He visited our hospital 2 months later presenting with hallucinations, delusions, mild cognitive decline, and faciobrachial dystonic seizures in the left upper extremity and face. Fluid-attenuated inversion recovery magnetic resonance imaging revealed swelling and hyperintensities in the right caudate nucleus and putamen. Cerebrospinal fluid analysis did not show increased protein levels or cell counts and revealed positive oligoclonal bands. Subsequently, positive results for anti-LGI1 antibodies were observed in the cerebrospinal fluid. Therefore, the patient was diagnosed with anti-LGI1 encephalitis. Conclusion: This case highlights the need to consider anti-LGI1 encephalitis therapy in patients with acute-onset psychiatric symptoms.
RESUMO
Objective: Identifying factors associated with poor outcomes in patients with delirium is important for predicting prognosis. This retrospective study developed an easy and objective cognitive function measurement scale that can predict the prognosis and mortality related to delirium. Methods: Fifty-five patients aged ≥65 years and diagnosed with delirium were included. Objective data regarding attention and orientation related to time and place were extracted from their medical records during the first consultation, and in total, six points were evaluated. The patients were categorized into high and low cognitive function (LCF) groups. The severity at the first visit and 1-week post-treatment was evaluated using the Clinical Global Impressions-Severity scale. Outcomes (survival or death) at 6 months from the initial visit were evaluated by reviewing medical records. Results: Although the Clinical Global Impressions-Severity score at the first visit was not significantly different between the two groups, 1 week after treatment, it was significantly lower in the high cognitive function (HCF) group than in the LCF group. Regarding the outcome (survival or death) after 6 months, the LCF group had significantly higher mortality than the HCF group. A multivariate logistic regression analysis revealed the same result (OR = 17.049, 95% CI = 2.415-120.373, p = 0.004). Conclusion: A simple cognitive assessment of attention and orientation may help predict unfavorable outcomes, including mortality, in patients with delirium.
