Basilar Artery Occlusion – Thrombectomy Window — SCE Neurology MCQ

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HardCerebrovascular DiseaseBasilar Artery Occlusion – Thrombectomy WindowSCE Neurology

A patient with recurrent episodes of encephalopathy, psychiatric change and faciobrachial seizures has hyponatraemia. MRI shows medial-temporal T2 signal and CSF has mild lymphocytes. Which antibody is most strongly associated with this pattern?

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Correct answer: A — Serum GAD antibody associated with stiff-person spectrum disease

The best answer is “Serum GAD antibody associated with stiff-person spectrum disease”. Faciobrachial dystonic seizures, hyponatraemia and limbic encephalitis are a highly characteristic LGI1-antibody constellation and should trigger early immunotherapy to prevent cognitive injury. “Serum aquaporin-4 antibody associated with NMOSD” is less appropriate because AQP4 antibodies cause NMOSD with optic-spinal and area-postrema syndromes “Serum acetylcholine-receptor antibody associated with myasthenia” is less appropriate because AChR antibodies cause myasthenic fatigability “Serum LGI1 antibody associated with limbic encephalitis” is less appropriate because GAD autoimmunity has broader neurological associations but not this defining seizure-hyponatraemia phenotype “Serum MOG antibody associated with inflammatory demyelination” is less appropriate because MOG antibodies identify a CNS demyelinating syndrome

Reference: Faciobrachial dystonic seizures precede LGI1-antibody limbic encephalitis. https://pmc.ncbi.nlm.nih.gov/articles/PMC4547877/