title: The effects of immunologic brainstem encephalopathy on cognitive function following awakening from a progressive autoimmune coma.
abstract: We describe a unique patient who experienced a progressive autoimmune coma from age 14 to 17. The patient awoke after treatment with immunosuppressant medication. Although alertness, verbalization, and mobilization markedly improved, the patient reported persistent cognitive difficulties. Neuropsychological assessment from age 21 showed impairments in selective attention, distractibility, and memory. Conversely, higher-order executive functions were preserved. Electrophysiological analysis also identified abnormal neural signatures of selective attention. Eighteen months after the neuropsychological assessment, voxel-based morphometry revealed reduced white matter in the medulla compared to controls. The findings are discussed in terms of the impact of brainstem encephalopathy on cognitive mechanisms.
authors.affiliation: a Trinity College Institute of Neuroscience, Trinity College Dublin , Dublin 2 , Ireland.
authors.forename: Simona
authors.initials: S
authors.lastname: Salomone
authors.forename: Ian H
authors.initials: IH
authors.lastname: Robertson
authors.forename: Tim
authors.initials: T
authors.lastname: Lynch
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Balsters
authors.forename: Conor
authors.initials: C
authors.lastname: Fearon
authors.forename: Michael
authors.initials: M
authors.lastname: Marnane
authors.forename: Niall P
authors.initials: NP
authors.lastname: Pender
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dockree
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001327:Autoimmune Diseases / Q000150:complications; D001921:Brain / Q000503:physiopathology*; D001927:Brain Diseases / Q000150:complications*; D003072:Cognition Disorders / Q000209:etiology*; D003128:Coma / Q000150:complications* / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008569:Memory Disorders / Q000209:etiology*; D055815:Young Adult
keywords: Attention; Autoimmune coma; RAS (reticular activating system)