Voltage-gated potassium channel
References
Age and Ageing 2014; 43: 583–585 doi: 10.1093/ageing/afu064 Published electronically 6 June 2014
Received 10 December 2013; accepted in revised form 26 March 2014
© The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: [email protected]
Voltage-gated potassium channel antibody-associated limbic encephalitis ATIF SALEEM1, RANI SOPHIA2 1
Medicine, Yeovil District Hospital NHS Foundation Trust, Yeovil District Hospital Higher Kingston, Yeovil, Somerset BA21 4AT, UK 2 Medicine (Care of the Elderly), Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset, UK Address correspondence to: Atif Saleem. Tel: +44 7550744915. Email: [email protected]
Abstract We are emphasising the importance of considering a rare diagnosis, voltage-gated Potassium channel antibody-associated limbic encephalitis, in an 80-year-old gentleman who presented with memory impairment, seizure and hyponatraemia. He was found to have high titre of voltage-gated potassium channel antibodies in his serum. He was given high-dose steroids and he responded biochemically and clinically with marked improvement in symptomatology. Keywords: encephalitis, limbic encephalitis, VGKC antibody-associated encephalitis, older people
Case report An 80-year-old gentleman, with a history of dual chamber pacemaker inserted in 2011 for sinus arrest, presented with falls. He was commenced recently on carbamazepine for generalised tonic clonic seizures. His general physical and systemic examinations were unremarkable; his abbreviated mental score was 10/10. His blood
tests showed sodium of 121. Other baseline blood tests were normal. 24-h electrocardiogram showed functioning pacemaker. CT head showed moderate global atrophy. After extensive investigations, low sodium was thought to be due to antiepileptic. The neurology team diagnosed him as immune-mediated encephalitis based on increasing falls, short-term memory loss (reported by his wife and evening ward staff), seizures and low
583
Downloaded from http://ageing.oxfordjournals.org/ at Mount Allison University on June 27, 2015
1. Uzunhan Y, Cadranel J, Boissel N, Gardin C, Arnulf B, Bergeron A. Lung involvement in lymphoid and lymphoplasmocytic proliferations (except lymphomas). Rev Mal Respir 2010; 6: 599–610. 2. Dimopoulos MA, Anagnostopoulos A. Waldenström’s xmacroglobulinemia. Best Pract Res Clin Haematol 2005; 4: 747–65. 3. Antón E. Chylothorax in hematologic malignancies. Chest 2005; 5: 1866–7. 4. Antón Aranda E. Chylothorax complicating Waldenström macroglobulinemia. Arch Bronconeumol 2001; 3: 155–6. 5. Rice TW, Milstone AP. Chylothorax as a result of chronic lymphocytic leukemia: case report and review of the literature. South Med J 2004; 3: 291–4. 6. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010; 1: 1–8.
7. Misaki S, Sakoda H, Hakata S, Shigematsu M, Hoshida Y. Waldenström macroglobulinemia complicated with chylothorax. Rinsho Ketsueki 2012; 11: 1916–20. 8. Rizzo S, Campagnoli M. Chylothorax as a complication of Waldenström’s disease. Eur J Respir Dis 1984; 5: 371–2. 9. Monteagudo M, Lima J, Garcia-Bragado F, Alvarez J. Chylous pleural effusion as the initial manifestation of Waldenström’s macroglobulinemia. Eur J Respir Dis 1987; 5: 326–7. 10. Martí JM, Cervantes F, Lloberes P, Cañete JD, Picado C, Rozman C. Chylothorax as the initial manifestation of Waldenström’s macroglobulinemia. Med Clínica 1987; 15: 591–3.
A. Saleem and R. Sophia Table 1. An overview of investigation findings in some causes of limbic encephalitisa Herpes simplex encephalitis
Paraneoplastic limbic encephalitis
VGKC-limbic encephalitis
Neuropil limbic encephalitis
.................................................................................... MRI temporal lobe signal change EEG abnormalities CSF abnormalities Raised white cells Raised protein Hyponatraemia Serum antibody
++ ++
+ ++
++ ++
++ ++
++ (10–200/mm3) ++ (0.6–6 g/l) +/− −
+/− (
References
Age and Ageing 2014; 43: 583–585 doi: 10.1093/ageing/afu064 Published electronically 6 June 2014
Received 10 December 2013; accepted in revised form 26 March 2014
© The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: [email protected]
Voltage-gated potassium channel antibody-associated limbic encephalitis ATIF SALEEM1, RANI SOPHIA2 1
Medicine, Yeovil District Hospital NHS Foundation Trust, Yeovil District Hospital Higher Kingston, Yeovil, Somerset BA21 4AT, UK 2 Medicine (Care of the Elderly), Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset, UK Address correspondence to: Atif Saleem. Tel: +44 7550744915. Email: [email protected]
Abstract We are emphasising the importance of considering a rare diagnosis, voltage-gated Potassium channel antibody-associated limbic encephalitis, in an 80-year-old gentleman who presented with memory impairment, seizure and hyponatraemia. He was found to have high titre of voltage-gated potassium channel antibodies in his serum. He was given high-dose steroids and he responded biochemically and clinically with marked improvement in symptomatology. Keywords: encephalitis, limbic encephalitis, VGKC antibody-associated encephalitis, older people
Case report An 80-year-old gentleman, with a history of dual chamber pacemaker inserted in 2011 for sinus arrest, presented with falls. He was commenced recently on carbamazepine for generalised tonic clonic seizures. His general physical and systemic examinations were unremarkable; his abbreviated mental score was 10/10. His blood
tests showed sodium of 121. Other baseline blood tests were normal. 24-h electrocardiogram showed functioning pacemaker. CT head showed moderate global atrophy. After extensive investigations, low sodium was thought to be due to antiepileptic. The neurology team diagnosed him as immune-mediated encephalitis based on increasing falls, short-term memory loss (reported by his wife and evening ward staff), seizures and low
583
Downloaded from http://ageing.oxfordjournals.org/ at Mount Allison University on June 27, 2015
1. Uzunhan Y, Cadranel J, Boissel N, Gardin C, Arnulf B, Bergeron A. Lung involvement in lymphoid and lymphoplasmocytic proliferations (except lymphomas). Rev Mal Respir 2010; 6: 599–610. 2. Dimopoulos MA, Anagnostopoulos A. Waldenström’s xmacroglobulinemia. Best Pract Res Clin Haematol 2005; 4: 747–65. 3. Antón E. Chylothorax in hematologic malignancies. Chest 2005; 5: 1866–7. 4. Antón Aranda E. Chylothorax complicating Waldenström macroglobulinemia. Arch Bronconeumol 2001; 3: 155–6. 5. Rice TW, Milstone AP. Chylothorax as a result of chronic lymphocytic leukemia: case report and review of the literature. South Med J 2004; 3: 291–4. 6. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010; 1: 1–8.
7. Misaki S, Sakoda H, Hakata S, Shigematsu M, Hoshida Y. Waldenström macroglobulinemia complicated with chylothorax. Rinsho Ketsueki 2012; 11: 1916–20. 8. Rizzo S, Campagnoli M. Chylothorax as a complication of Waldenström’s disease. Eur J Respir Dis 1984; 5: 371–2. 9. Monteagudo M, Lima J, Garcia-Bragado F, Alvarez J. Chylous pleural effusion as the initial manifestation of Waldenström’s macroglobulinemia. Eur J Respir Dis 1987; 5: 326–7. 10. Martí JM, Cervantes F, Lloberes P, Cañete JD, Picado C, Rozman C. Chylothorax as the initial manifestation of Waldenström’s macroglobulinemia. Med Clínica 1987; 15: 591–3.
A. Saleem and R. Sophia Table 1. An overview of investigation findings in some causes of limbic encephalitisa Herpes simplex encephalitis
Paraneoplastic limbic encephalitis
VGKC-limbic encephalitis
Neuropil limbic encephalitis
.................................................................................... MRI temporal lobe signal change EEG abnormalities CSF abnormalities Raised white cells Raised protein Hyponatraemia Serum antibody
++ ++
+ ++
++ ++
++ ++
++ (10–200/mm3) ++ (0.6–6 g/l) +/− −
+/− (
