A Unique Shape of Brainstem Lesion that Caused Orthostatic Hypotension in Anti-NMDAR Encephalitis

Intern Med. 2019 Oct 1;58(19):2861-2864. doi: 10.2169/internalmedicine.2805-19. Epub 2019 Jun 7.


After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis.

Keywords: anti-NMDAR encephalitis; arginine vasopressin; blink reflex; brainstem auditory-evoked potentials; magnetic resonance imaging; orthostatic hypotension.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
  • Brain Stem / diagnostic imaging*
  • Electroencephalography
  • Female
  • Humans
  • Hypotension, Orthostatic / diagnosis
  • Hypotension, Orthostatic / etiology*
  • Magnetic Resonance Imaging