| Abstract [eng] |
Autoimmune encephalitis is an antibody-mediated inflammation of the brain, associated with clinical presentation of seizures, altered mental status, memory impairment, focal neurological and psychiatric symptoms. Autoimmune origin indicates that endogenous antibodies against certain proteins are involved in the pathogenesis. Associated with neurological conditions such as stiff-person syndrome, cerebellar ataxia, and others, glutamic acid decarboxylase-65 antibodies are increasingly more often recognized in pediatric autoimmune encephalitis. Although the spectrum of detectable antibodies is expanding, autoimmune encephalitis is still a difficult neurological condition to diagnose, especially when antibodies can’t be detected in the patient’s blood or the cerebrospinal fluid. This case report presents a 5-year-old patient who developed neurological symptoms while being ill with the flu. She was administered to an intensive care unit, where her condition was severe along with disorientation, limb dyskinesia, orofacial movement, and sensorimotor aphasia. Based on clinical examination, laboratory test results, and imaging, a seronegative and magnetic-resonance-imaging-negative autoimmune encephalitis was diagnosed. In the acute phase, the patient was treated with intravenous immunoglobulin and methylprednisolone pulse therapy. Receiving proper treatment the patient's condition improved and stabilized within 13 days. For almost 3 years, a difficult journey of autoimmune encephalitis treatment continued, accompanied by an onset of severe refractory epilepsy. When the patient was 8-years-old, the antibodies were finally identified and glutamic acid decarboxylase-65 antibody-mediated autoimmune encephalitis was diagnosed retrospectively. The literature review summarizes the important aspects of autoimmune encephalitis presentation, diagnosis, and treatment together with significant glutamic acid decarboxylase-65 antibody relations. Important differential diagnosis aspects are reviewed. It’s explored how a retrospective diagnosis changes the established treatment strategy. |
