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A 17-year-old girl with encephalomyelitis

Teaching . Neuro. Images. Neurology. Resident and Fellow Section. © . 2015 . American Academy of Neurology. A . 17-year. -old girl presented with a month of anxiety followed by acute psychosis, catatonia, .

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A 17-year-old girl with encephalomyelitis






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A 17-year-old girl with encephalomyelitis

Teaching NeuroImagesNeurologyResident and Fellow Section

© 2015 American Academy of Neurology

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A 17-year-old girl presented with a month of anxiety followed by acute psychosis, catatonia, choreo-athetosis, seizures, autonomic instability, lower extremity spasticity, and hyperreflexia. CSF was positive for the NMDA antibody; additional antibodies and infectious etiologies tested negative. MRI brain was normal. MRI spine revealed symmetric T2 hyperintensities in ventral gray matter (Fig 1). EEG showed extreme delta brush. She received sequentially: IV Ig, methylprednisolone, resection of ovarian teratoma, and plasmapheresis, all without much improvement. Rituximab led to significant improvement.Myelopathy, present on the initial encounter, gradually improvedAt 3 months, repeat MRI spine and motor exam were normal

Zubkov et al

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© 2015 American Academy of Neurology

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Imaging

Zubkov et al

©

2015 American Academy of Neurology

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A 17-year-old girl with encephalomyelitis

NMDA encephalitis with myelopathy is rarePreviously reported cases had MRI brain abnormalities at time of abnormal MRI spine1,2One prior case mimicked the clinical presentation of NMO1Spinal cord gray matter involvement has not been previously reported.

Zubkov et al

© 2015 American Academy of Neurology