Wakeup,Mommy!-McGillUniversity.pptVIP

* Anti-NMDAR Encephalitis:The McGill Experience Dr. Amy Yu, R2 Neurology Dr. Suhail Al-Rukn, R5 Neurology February 12th 2010 Case presentation ID: 29F presents to ER September 20th 2009 RFC: Persistent headache, memory changes, and sensations of “déjà vu” PMHx: Vaginal delivery July 6th 2009 (11 weeks post-partum) Headache (CSF leak from epidural, Rx with caffeine pills) Married for 3 years, denies EtOH/drugs/tobacco Works as Program Coordinator at McGill Genetics Department No medications, NKDA Case presentation – HPI 2-3 weeks difficulty dealing with the newborn, decreased sleep/energy/appetite Patient reported 3/10 constant headache, bilateral fronto-occipital, worse in the morning, relieved with Tylenol, no N/V Denies hallucinations, infanticidal thoughts/actions During the HP, patient appears anxious, repetitive questioning E.g. “Why did I loose my memory?” “Haven’t you asked me this before?” Case presentation – Physical exam Vitals were within normal limits, afebrile Unremarkable cardiopulmonary exam Neurological Mental status: Oriented to time, date, place, registration 3/3, recall 0/3 CN exam unremarkable Motor: normal tone, 5/5 power, and 3+ reflexes symmetrically Sensory: normal to light touch and pinprick No limb dysmetria, normal gait Initial labs were within normal limits (normal WBC) Plain CT head were unremarkable Overview of initial course in JGH Sept 20: Admission to psychiatry Post-partum depression with psychotic features Started on antipsychotics and received ECT Catatonic state, minimal PO intake, family reports abnormal movements Sept 28: “Code blue” for status epilepticus and transfer to ICU Continuous chewing movement around ETT Athetotic movement of the hands and fingers Variable ocular exam (ocular bobbing, convergence spasm) Investigations MRI head with Gadolinium 3 non-specific FLAIR hyperintensities (occipital horn of left lateral ventricle) subcentimetric, non-enhancing Symmetric temporal lobes, no enhancement MRV revealed no venous