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

Murakami, Takenobu; Nakatani-Enomoto, Setsu; Enomoto, Hiroyuki; Takahashi, Yukitoshi; Ugawa, Yoshikazu

doi:10.2169/internalmedicine.2805-19

Cited by 3 publications

(3 citation statements)

References 10 publications

(11 reference statements)

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“…Central hyperthermia/hypothermia, arrhythmia (sinus tachycardia/ sinus bradycardia), 4,5 abnormal blood pressure (hypertension/hypotension), 17 mydriasis, central hypoventilation/hyperventilation, sweating, salivary hypersecretion, urinary and intestinal dysfunction, and sexual dysfunction (erectile dysfunction) are mainly caused by hypo-or hyperactivity of the autonomic nervous system. Patients mainly die of respiratory or circulatory dysfunction and failure; therefore, critical patients usually require cardiac pacemaker implantation or respiratory assistance.…”

Section: Autonomic Nervous System Dysfunctionmentioning

confidence: 99%

Autonomic manifestations in autoimmune encephalitis

Takamatsu

Nakane

2021

Neurology & Clinical Neurosc

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Autoimmune encephalitis represented by anti-NMDA receptor antibody positive encephalitis is a type of nonherpetic limbic encephalitis, and it is well known that emotional and memory disorders manifest as limbic symptoms. However, it should be noted that autonomic dysfunction is also an important symptom of limbic system dysfunction. Autonomic manifestations of autoimmune encephalitis include not only general physical symptoms such as high fever, sweating, and bladder and rectal disorders, but also life-threatening symptoms such as large fluctuations in blood pressure and pulse, and central apnea, which require treatment in the intensive care unit. This review outlines autoimmune encephalitis with autonomic symptoms and summarizes reports on each antibody that causes autoimmune encephalitis.

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Section: Autonomic Nervous System Dysfunctionmentioning

confidence: 99%

Autonomic manifestations in autoimmune encephalitis

Takamatsu

Nakane

2021

Neurology & Clinical Neurosc

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“…[9] The relationship between autoimmune encephalitis and hypotension is not clear, but several reports have shown that some patients with autoimmune encephalitis developed hypotension or orthostatic hypotension during treatment. [5][6][7]10,11] Among these patients, some had lesions involving the brainstem, [5,7,11] some had lesions in the hippocampal region, and some had specific autoantibodies. [5][6][7]11] These factors may be related to autonomic dysfunction or the influence of the central nervous system on peripheral vascular regulation.…”

Section: Discussionmentioning

confidence: 99%

“…This may be related to multiple mechanisms such as the suppression of the autoimmune response by steroids, the protection of vascular endothelial function, and the activation of the vasoconstrictor system. [ 10 , 12 , 13 ] Some patients with autoimmune encephalitis also showed improvement in hypotension or orthostatic hypotension after receiving high-dose steroid pulse therapy, [ 6 , 7 , 11 ] while we used low-dose steroid pulse therapy with positive results. However, there are currently no unified guidelines or consensus on the use and dosage of steroids in the treatment of post-encephalitis hypotension.…”

Section: Discussionmentioning

confidence: 99%

A case of successful hormone therapy for refractory hypotension following viral encephalitis: Case report

Zhang,

Liao

2023

Medicine

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Rationale: Refractory hypotension is a life-threatening condition that can result from various causes. We report a rare case of refractory hypotension following herpes simplex virus type 1 encephalitis that was successfully treated with hormone therapy. Patient concerns: The patient was a 66-year-old male who was admitted to the hospital because of fever, chills, convulsions, and impaired consciousness. He developed respiratory failure and was intubated. Cerebrospinal fluid metagenomic sequencing confirmed herpes simplex virus type 1 infection. He received piperacillin-tazobactam for anti-infection, acyclovir for antiviral therapy, and dexamethasone for anti-inflammatory therapy. He had repeated episodes of hypotension despite fluid resuscitation and vasopressor therapy. Diagnosis: The diagnosis of herpes simplex virus type 1 encephalitis complicated by refractory hypotension was based on the patient’s epidemiological history, clinical manifestations, laboratory tests, and imaging studies. Cerebrospinal fluid examination was the most important diagnostic method, which could detect viral nucleic acids. Head magnetic resonance imaging showed a large recent lesion in the right temporal-parietal and insular lobes. Interventions: The treatment of refractory hypotension mainly included anti-infection, antiviral, anti-inflammatory, and hormone therapy. Hormone therapy used methylprednisolone shock treatment until tapering withdrawal. Other treatments included fluid resuscitation, vasopressors, anticonvulsants, etc. Outcomes: The patient’s blood pressure stabilized after receiving methylprednisolone shock treatment, and his mean arterial pressure increased from 73 mm Hg to 92 mm Hg within 24 hours. Three months later, the patient’s blood pressure was normal without medication, and he had a good social and physical recovery. Lessons: This case illustrates the possible role of hormone therapy in restoring blood pressure in patients with refractory hypotension following viral encephalitis. It suggests that adrenal insufficiency or autonomic dysfunction may be involved in the pathophysiology of this condition. Further studies are needed to confirm the efficacy and safety of hormone therapy in this setting.

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Can auditory brain stem response accurately reflect the cochlear function?

Ding

Zhang

et al. 2020

Journal of Neurophysiology

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Auditory brainstem response (ABR) and cochlear compound action potential (CAP) are widely used for hearing assessment. Due to easy detection, ABR is more commonly used to evaluate cochlear lesions than CAP. Since ABR reflects the central auditory response in the brain, and CAP reflects the auditory nerve function of the cochlea, ABR is not the same as CAP. In order to see the difference between ABR and CAP, two cochlear injury models were observed. In ae noise-induced cochlear damage model, chinchillas were exposed to 105 dB SPL narrow-band noise for 5 hours. One day after the noise, the thresholds of CAP and ABR increased to the same level with permanent hair cell loss. 30 days later, the elevated CAP threshold remains unchanged, but the ABR threshold was significantly reduced about 20 dB. This phenomenon may be due to the irreversible weakening of CAP and the enhancement of ABR by central reorganizition. In another experimental model of unilateral cochlear destruction in guinea pigs, both ABR and CAP were affected by cross-hearing. When ABR was tested from the destroyed ear, a shadow-curve of ABR from the contralateral healthy ear masked the hearing loss in the destroyed ear. In contrast, the typical CAP waveform disappeared which was replaced by an ABR-like waveform from the opposite healthy ear. The results indicate that ABR may not faithfully reflect the functional status of the cochlea, and provide a clue of the occurrence of cross-hearing when subjects have asymmetric hearing loss.

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

Cited by 3 publications

References 10 publications

Autonomic manifestations in autoimmune encephalitis

Autonomic manifestations in autoimmune encephalitis

A case of successful hormone therapy for refractory hypotension following viral encephalitis: Case report

Can auditory brain stem response accurately reflect the cochlear function?

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