PMID- 22669927
OWN - NLM
STAT- MEDLINE
DCOM- 20131219
LR  - 20211021
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2012
DP  - 2012 Jun 1
TI  - Seizures and postictal stupor in a patient with uncontrolled Graves' 
      hyperthyroidism.
LID - 10.1136/bcr.02.2012.5929 [doi]
LID - bcr0220125929
AB  - A 16-year-old girl with a history of Graves' disease presented with two episodes 
      of generalised tonic-clonic seizures, necessitating intensive care admission. 
      Laboratory examination demonstrated a suppressed thyroid-stimulating hormone 
      level with dramatically elevated free triiodothyronine, free thyroxine and 
      thyroid-stimulating immunoglobulins. Cerebrospinal fluid analysis showed 
      oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies 
      or infection. Neuroimaging revealed the presence of a congenital arachnoid cyst 
      in the right temporal lobe. Despite restoration of euthyroidism and 
      administration of antiepileptic and antiviral drugs, neurological features 
      persisted. Subsequently, intravenous corticoids were administered to exclude the 
      contribution of an underlying autoimmune encephalopathy. The patient gradually 
      recovered and, in retrospect, elevated serum N-methyl-D-aspartic acid-receptor 
      (NMDA-R) antibodies were detected. Although this patient presented with an 
      intracerebral arachnoid cyst that can act epileptogenic per se, the combination 
      of prolonged postictal encephalopathy with unresponsiveness to antiepileptic 
      measures, absence of focal epileptiform activity on EEG, response to corticoids 
      and serum NMDA-R antibody positivity favours the diagnosis of autoimmune NMDA-R 
      encephalitis in this case.
FAU - De Leu, Nico
AU  - De Leu N
AD  - Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, 
      Belgium.
FAU - Unuane, David
AU  - Unuane D
FAU - Poppe, Kris
AU  - Poppe K
FAU - Velkeniers, Brigitte
AU  - Velkeniers B
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20120601
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Anticonvulsants)
RN  - 0 (Antithyroid Agents)
RN  - 9002-71-5 (Thyrotropin)
RN  - Q51BO43MG4 (Thyroxine)
SB  - IM
MH  - Adolescent
MH  - Anticonvulsants/*therapeutic use
MH  - Antithyroid Agents/*therapeutic use
MH  - Diagnosis, Differential
MH  - Drug Therapy, Combination
MH  - Electroencephalography
MH  - Female
MH  - Graves Disease/blood/*complications/drug therapy
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Seizures/diagnosis/drug therapy/*etiology
MH  - Stupor/diagnosis/drug therapy/*etiology
MH  - Thyrotropin/blood
MH  - Thyroxine/blood
PMC - PMC4542433
COIS- Competing interests: None.
EDAT- 2012/06/07 06:00
MHDA- 2013/12/20 06:00
PMCR- 2014/06/01
CRDT- 2012/06/07 06:00
PHST- 2012/06/07 06:00 [entrez]
PHST- 2012/06/07 06:00 [pubmed]
PHST- 2013/12/20 06:00 [medline]
PHST- 2014/06/01 00:00 [pmc-release]
AID - bcr.02.2012.5929 [pii]
AID - 10.1136/bcr.02.2012.5929 [doi]
PST - epublish
SO  - BMJ Case Rep. 2012 Jun 1;2012:bcr0220125929. doi: 10.1136/bcr.02.2012.5929.