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Autoimmune limbic encephalitis with seizures — SCE Neurology MCQ

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HardEpilepsyAutoimmune limbic encephalitis with seizuresSCE Neurology

A 55-year-old woman presented with new focal seizures with subacute memory impairment and psychiatric change. On examination, there was disorientation and hyponatraemia without meningism. Initial investigations showed: MRI showed bilateral mesial temporal FLAIR hyperintensity; LGI1 antibodies were positive. What is the most likely diagnosis?

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Correct answer: B — Autoimmune limbic encephalitis with seizures

Autoimmune limbic encephalitis with seizures is the best answer because the vignette describes Autoimmune limbic encephalitis with seizures: subacute limbic syndrome with faciobrachial or focal seizures and LGI1 antibodies indicates autoimmune limbic encephalitis. Epilepsy with driving restriction is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Febrile seizure in an adult mimic and First unprovoked seizure are less appropriate because they would require different localisation, timing or test findings; Absence seizures would fit a different syndrome. Clinical pearl: HSV encephalitis is important but usually has fever and CSF pleocytosis.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive