title: Acute limbic encephalitis with focal hyperperfusion on single photon emission computed tomography.
abstract: Here we report an 11-year-old boy with acute encephalopathy with neuropsychiatric symptoms. The patient had mildly decreased consciousness, delirious behavior, and affective changes next day of fever onset. Hematologic, biochemical, and metabolic examinations were unremarkable. CSF analysis revealed cell counts of 278 cells/mm(3) and a protein level of 87 mg/dL. Although MRI revealed no abnormal findings, an increase in regional cerebral blood flow was present in the bilateral frontal lobes, mesial temporal lobes, and basal ganglia on single photon emission computed tomography. The measurement of the concentrations of biomarkers such as cytokines in the patient's serum and cerebrospinal fluid revealed elevated levels of IL-4 and TNF-α in the cerebrospinal fluid. Immunohistochemical studies applying control human brain sections did not demonstrate the presence of autoantibodies. We considered that innate immunity rather than autoantibody response may have contributed to the neuropsychiatric symptoms of our patient. These results suggest heterogeneity of patients with acute encephalopathy with neuropsychiatric symptoms.
authors.affiliation: Department of Pediatrics, Koto Hospital, Japan. ayuko421@yahoo.co.jp
authors.forename: Ayuko
authors.initials: A
authors.lastname: Igarashi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
authors.forename: Yuri
authors.initials: Y
authors.lastname: Kitamura
authors.forename: Keisuke
authors.initials: K
authors.lastname: Jinbo
authors.forename: Sei
authors.initials: S
authors.lastname: Akatsuka
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Tanuma
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hayashi
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D003244:Consciousness Disorders / Q000209:etiology; D016207:Cytokines / Q000097:blood / Q000134:cerebrospinal fluid; D006801:Humans; D007150:Immunohistochemistry; D020363:Limbic Encephalitis / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015415:Biomarkers; D016207:Cytokines