title: Two different presentations, one diagnosis.
abstract: Acute confusion and hyponatraemia are common presentations in acute medicine. We report two cases of anti-voltage gated potassium channel (VGKC) antibody-related limbic encephalitis highlighting the variable presentation of this condition. Both patients were thoroughly investigated with MRI scan of brain, lumbar puncture, EEG as well as infective and autoimmune screens for encephalitis. Anti-VGKC antibodies were positive for both patients and prompt treatment with immunotherapy yielded good recovery. Patients presenting with confusion and seizures who have no demonstrable infectious or metabolic cause should have investigation for an autoimmune cause expedited. In addition, psychiatric presentations with atypical features such as drowsiness should prompt similar investigations. The outcome of anti-VGKCrelated limbic encephalitis is improved with early treatment employing steroids or immunotherapy.
authors.affiliation: FY1, Altnagelvin Area Hospital.
authors.forename: Gavin
authors.initials: G
authors.lastname: McCluskey
authors.affiliation: CT1 Anaesthetics, University College Hospital, London.
authors.forename: Chandni K
authors.initials: CK
authors.lastname: Rajani
authors.affiliation: ST5 Specialist Registrar Renal and General Medicine, Altnagelvin Area Hospital.
authors.forename: Gareth
authors.initials: G
authors.lastname: Lewis
authors.affiliation: ST1 general practice, Northwick Park Hospital, London.
authors.forename: Vibhu
authors.initials: V
authors.lastname: Kaushal
authors.affiliation: Consultant Rheumatologist, Altnagelvin Area Hospital.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Gardiner
authors.affiliation: Locum Consultant Liaison Psychiatrist, Central and North West London NHS Foundation Trust.
authors.forename: Pamela
authors.initials: P
authors.lastname: Jee
authors.affiliation: Consultant Neurologist, Northwick Park Hospital and National Hospital for Neurology and Neurosurgery.
authors.forename: Anand
authors.initials: A
authors.lastname: Trip
authors.affiliation: Consultant Neurologist, Altnagelvin Area Hospital.
authors.forename: Mark O
authors.initials: MO
authors.lastname: McCarron
authors.affiliation: Consultant Acute Physician, Northwick Park Hospital.
authors.forename: Jacob F
authors.initials: JF
authors.lastname: de Wolff
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020363:Limbic Encephalitis / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology; D013129:Spinal Puncture / Q000379:methods*