2017 Volume 34 Issue 1 Pages 47-50
A 69–year–old man developed gait disturbance and apathy. He had mild cognitive impairment, apathy, and parkinsonism at the first admission followed by subacute cognitive dysfunction. T2 weighted brain magnetic resonance imaging (MRI) showed high intensity lesions in bilateral basal ganglia with partial gadolinium enhancement. Steroid pulse therapy was performed under the diagnosis of autoimmune encephalitis and cognitive function was improved. However, he relapsed after 1 month. Brain MRI showed enlarged lesions including limbic system. Then, he hospitalized again and steroid pulse therapy was performed, followed by the improvement in both clinically and MRI findings. Seizure was not exhibited during the clinical course. CSF anti–NMDA receptor antibody turned out to be positive after discharge. Although anti–NMDAR antibody encephalitis is usually presented with psychiatric symptoms and seizure, the main symptom was parkinsonism in our case. Our atypical case suggests that anti–NMDAR antibody should be measured even if the symptom is mild cognitive impairment and parkinsonism without seizure.
