Medicine, Yeovil District Hospital NHS Foundation Trust, Yeovil District Hospital Higher Kingston, Yeovil, Somerset BA21 4AT, UK 2 Medicine (Care of the Elderly), Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset, UK Address correspondence to: Atif Saleem. Tel: +44 7550744915. Email: [email protected]
Abstract We are emphasising the importance of considering a rare diagnosis, voltage-gated Potassium channel antibody-associated limbic encephalitis, in an 80-year-old gentleman who presented with memory impairment, seizure and hyponatraemia. He was found to have high titre of voltage-gated potassium channel antibodies in his serum. He was given high-dose steroids and he responded biochemically and clinically with marked improvement in symptomatology. Keywords: encephalitis, limbic encephalitis, VGKC antibody-associated encephalitis, older people
Case report An 80-year-old gentleman, with a history of dual chamber pacemaker inserted in 2011 for sinus arrest, presented with falls. He was commenced recently on carbamazepine for generalised tonic clonic seizures. His general physical and systemic examinations were unremarkable; his abbreviated mental score was 10/10. His blood
tests showed sodium of 121. Other baseline blood tests were normal. 24-h electrocardiogram showed functioning pacemaker. CT head showed moderate global atrophy. After extensive investigations, low sodium was thought to be due to antiepileptic. The neurology team diagnosed him as immune-mediated encephalitis based on increasing falls, short-term memory loss (reported by his wife and evening ward staff), seizures and low
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A. Saleem and R. Sophia Table 1. An overview of investigation findings in some causes of limbic encephalitisa Herpes simplex encephalitis
Paraneoplastic limbic encephalitis
Neuropil limbic encephalitis
.................................................................................... MRI temporal lobe signal change EEG abnormalities CSF abnormalities Raised white cells Raised protein Hyponatraemia Serum antibody