Chronic Lithium Cerebellar Toxicity — SCE Neurology MCQ

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HardNeuropsychiatryChronic Lithium Cerebellar ToxicitySCE Neurology

A 69-year-old develops complex parasomnias with stridor and sleep apnoea, followed by axial rigidity, gait freezing, dysphagia and vertical supranuclear gaze limitation. MRI is non-diagnostic. Which neural antibody most closely matches this combined sleep and PSP-like syndrome?

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Correct answer: D — IgLON5 antibody

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

A is associated especially with faciobrachial dystonic seizures, amnesia and hyponatraemia. B may produce limbic encephalitis, neuropathic pain and peripheral nerve hyperexcitability. C often accompanies prodromal diarrhoea, weight loss and hyperekplexia or myoclonus. D is correct: IgLON5 disease characteristically combines polymorphic sleep disturbance, bulbar or respiratory sleep phenomena and a progressive PSP-like gait and eye-movement syndrome. E more often causes psychiatric change, seizures, dyskinesia and autonomic instability in younger patients.

Reference: Autoimmune encephalitis: clinical spectrum and management: https://pn.bmj.com/content/21/5/412