Cerebellar ataxia as the initial symptom with lesions involving the cerebellum in patient with anti-NMDAR encephalitis: A rare case report and literature review

Baojie Wang; Chunjuan Wang; Haitao Ren; Hongzhi Guan; Shougang Guo

doi:10.1016/j.jneuroim.2020.577293

Cerebellar ataxia as the initial symptom with lesions involving the cerebellum in patient with anti-NMDAR encephalitis: A rare case report and literature review

J Neuroimmunol. 2020 Jun 17:346:577293. doi: 10.1016/j.jneuroim.2020.577293. Online ahead of print.

Authors

Baojie Wang¹, Chunjuan Wang², Haitao Ren³, Hongzhi Guan³, Shougang Guo⁴

Affiliations

¹ Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong, China.
² Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
³ Peking Union Medical College Hospital, Beijing, China.
⁴ Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China. Electronic address: guoshougang1124@163.com.

PMID: 32590126
DOI: 10.1016/j.jneuroim.2020.577293

Abstract

Cerebellar ataxia is an atypical presentation of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. In patients with anti-NMDAR encephalitis, cerebellar ataxia often develops simultaneously or sequentially with clinical features of demyelinating disorders, paraneoplastic neurologic syndromes, despite unremarkable brain magnetic resonance imagerying (MRI) findings. Herein, we report a patient with anti-NMDAR encephalitis who developed dizziness and gait ataxia as the initial symptoms, simultaneously showing MRI hyperintensities involving the cerebellum, even before manifesting behavioral and cognitive symptoms. We excluded the co-occurrence of other autoantibodies using cell- and tissue-based assays to establish a confirmed diagnosis of definite anti-NMDAR encephalitis.

Keywords: Ataxia; Autoimmune encephalitis; Cerebellum.