title: Extreme delta brush in a patient with anti-NMDAR encephalitis.
abstract: Anti-N-methyl-D-aspartate receptor encephalitis is a severe, potentially treatable, disorder and prognosis depends on early recognition and prompt immunotherapy. We report a case of anti-N-methyl-D-aspartate receptor encephalitis with atypical age and gender, and a characteristic electroencephalographic pattern that supported the diagnosis. A 66-year-old male presented with psychiatric disturbances and focal seizures with alteration of consciousness, and progressed to a state of akinetic mutism. Auxiliary tests were negative or non-specific for anti-NMDAR encephalitis. Electroencephalographic monitoring revealed a unique pattern; the extreme delta brush. The patient improved with immunotherapy and was asymptomatic at six months of follow-up. Ancillary testing was positive for anti-N-methyl-D-aspartate receptor antibodies. Extreme delta brush is a recently described electroencephalographic pattern presenting in only one third of patients with anti-N-methyl-D-aspartate receptor encephalitis. The identification of this pattern, as in our case, may guide early diagnosis and treatment of anti-N-methyl-D-aspartate receptor encephalitis.
authors: Epilepsy Unit, Hospital Universitario Clinico San Carlos.
authors: Daniela
authors: D
authors: Di Capua
authors: Hospital Universitario Clinico San Carlos, Madrid, Spain, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors: Sara
authors: S
authors: García-Ptacek
authors: Epilepsy Unit, Hospital Universitario Clinico San Carlos.
authors: Maria Eugenia
authors: ME
authors: García-García
authors: Hospital Universitario Clinico San Carlos, Madrid, Spain.
authors: Belen
authors: B
authors: Abarrategui
authors: Hospital Universitario Clinico San Carlos, Madrid, Spain.
authors: Jesús
authors: J
authors: Porta-Etessam
authors: Epilepsy Unit, Hospital Universitario Clinico San Carlos.
authors: Irene
authors: I
authors: García-Morales
mesh_terms: D000368:Aged; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D001323:Autoantibodies / Q000134:cerebrospinal fluid / Q000276:immunology; D042241:Early Diagnosis; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D008297:Male; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate
keywords: VEEG; anti-NMDAR encephalitis; autoimmune encephalitis; extreme delta brush