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Paraneoplastic Limbic Encephalitis Case Report In A Patient With Suspected Conversion Disorder

Published online by Cambridge University Press:  01 September 2022

A.N. Duran Öztürk*
Affiliation:
Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychiatry, Istanbul, Turkey
O. Sahmelikoglu Onur
Affiliation:
Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychiatry, Istanbul, Turkey
N. Karamustafalioglu
Affiliation:
Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychiatry, Istanbul, Turkey
*
*Corresponding author.

Abstract

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Introduction

. Autoimmune encephalitis is a difficult-to-recognize, complex disease that can present with various neuropsychiatric symptoms. N-methyl-D-aspartate receptor (NMDA-r) and anti-leucine-rich glioma-inactivated 1 protein (LGI-1) subtypes of autoimmune encephalitis may present with psychiatric symptoms.

Objectives

We would like to present an autoimmune encephalitis case that can be confused with conversion disorder.

Methods

A 54-year-old, female patient started to have forgetfulness ten months ago, and convulsions started five months ago. The patient had disorganized behaviors and contractions in the extremities. Diffusion MRI and brain CT images were normal. The patient had low blood sodium level. In the follow-up, her orientation was impaired and she could hardly make eye contact. As the patient’s contractions were evaluated as conversion in the first stage, 50mg/day sertraline was added to the treatment.

Results

After cranial MRI and EEG recordings were completed, the patient was referred to the neurology department due to the suspicion of autoimmune encephalitis. In the cerebrospinal fluid examination anti-LGI-1 and anti-yo antibodies were positive. Thereupon, IV pulse steroid was given. After that her orientation and disorganized behavior improved. Then, the patient was referred to oncology department.

Conclusions

Limbic encephalitis may manifest as sleep disorders, short-term memory loss, conversion disorder, disorganized behaviors, slurred speech, non-epileptic seizures, sensory and motor defects. Delay in diagnosis may worsen the prognosis of possible malignancy. It should be kept in mind that the patient with a suspected conversion disorder may have limbic encephalitis.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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