[Differential diagnosis of encephalitis due to anti-NMDA receptor antibodies]. / Diagnóstico diferencial en la encefalitis por anticuerpos contra el receptor NMDA.

INTRODUCTION: Anti-NMDA receptor (NMDAR) encephalitis usually develops as a multistage syndrome with a broad differential diagnosis. PATIENTS: We report 2 patients with anti-NMDAR encephalitis and a clinical picture typical of this disorder but whose initial evaluation suggested other aetiologies. DISCUSSION: The frequent development of this disorder in young individuals presenting with psychiatric manifestations often suggests other diagnostic possibilities, most commonly viral encephalitis, psychiatric disorders, and neuroleptic malignant syndrome. In addition, several less clearly defined syndromes or descriptively reported disorders in adult and paediatric patients were likely cases of anti-NMDAR encephalitis. CONCLUSIONS: Anti-NMDAR encephalitis should be considered in young individuals with subacute presentation of psychiatric symptoms, abnormal movements, and autonomic dysfunction. The clinical and immunological characterization of this disorder has lead to the identification of new antibodies that affect memory, learning, behaviour and psychosis.

[Cerebral venous thrombosis: when etiology makes the difference]. / Trombosis venosa cerebral: cuando la etiología marca la diferencia.

OBJECTIVES: To make a retrospective study of the clinical, etiological, diagnostic and prognostic features of cerebral vein and sinus thrombosis (CVST) diagnosed at our University Hospital. METHODS: We performed a systematic research of the clinical records of our University Hospital's electronic database (1977-2009) using the key words <>. RESULTS: Ninety-five possible cases were found, and 16 were excluded due to alternative or uncertain diagnosis. Seventy-nine patients (43 females), median age of 46 years (2-82), were studied. Hereditary or acquired thrombophilia was detected in 22 patients (27.8%): prothrombin G20210A mutation (10), factor V Leyden (3), protein C deficiency (2), homozygous MTHFR C677T mutation (1), antiphospholipid syndrome (7) and hematological conditions (3). CVST was associated with infection in 17 cases, intracranial neoplasm in 9, malignancy in 13, treatment with prothrombotic drugs in 20 (including substitutive/antineoplastic hormones and oral contraceptives) and other causes in 8. Thirteen cases were idiopathic. Clinical presentation was intracranial hypertension in 83.5%, focal deficits in 45.6% and seizures in 12.6 %. Transverse (57%) and superior sagittal sinus (49.4%) were the most commonly involved. Seizures occurred in 25.3%, venous infarction in 41% and severe intracranial hypertension in 22.8 %. Up to 31.6 % required surgical drainage, decompressive craniectomy or ventricular drainage. Nine cases associated peripheral venous thromboembolism and 4 CVST recurred. Evolution was favorable (modified Rankin scale 0-2 at 3 months) in 74.7%. Mortality rate was 13.9% (11 patients). Neoplastic and infectious origin was significantly associated with mortality and disability. CONCLUSION: We describe a large retrospective series of CVST where infectious and neoplastic etiologies were linked to an unfavorable outcome.