RESUMO
A 52-year-old male patient with a background of adaptive personality disorder was admitted for mitral valve repair and cardiac ablation for atrial fibrillation. He suffered intraoperative complications with severe mitral insufficiency that suffered ischemia.. Post-operatively, he demonstrated acute loss of retrograde autobiographical memory, prosopagnosia and a loss of public semantic memory. His CT scan was normal and MRI was not possible due to intra-cardiac leads. An initial diagnosis of hypoxic-ischemic encephalopathy was considered. A neuropsychological examination undertaken 20 days after his surgery showed a severe alteration of retrograde autobiographical memory, marked alteration of semantic knowledge and prosopagnosia. He demonstrated an average performance in tasks measuring constructional praxis, visuospatial ability, and executive functions. 34 days after surgery, and after a short nap, the patient "returns" to the day before admission and consequently recovers his memory. Repeat neuropsychological assessment demonstrated performance within the normal range across all previously tested domains. This sudden recovery of memory, together with a normal MRI, led to a rethinking of the diagnosis of dissociative amnesia. This case illustrates the long-standing discussion about the organic or functional origin of some memory disorders, in which, despite advances in neuroimaging techniques, it is still difficult to know their etiology .
Assuntos
Memória Episódica , Prosopagnosia , Masculino , Humanos , Pessoa de Meia-Idade , Filmes Cinematográficos , Prosopagnosia/complicações , Amnésia/etiologia , Testes Neuropsicológicos , Amnésia Retrógrada/diagnóstico , Amnésia Retrógrada/etiologiaAssuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Prosopagnosia/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neurologia/educação , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Tomografia por Emissão de Pósitrons , Prosopagnosia/complicações , Prosopagnosia/patologia , Teratoma/complicações , Teratoma/patologia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Encefalite Límbica/imunologia , Prosopagnosia/tratamento farmacológico , Prosopagnosia/imunologia , Receptor de Glutamato Metabotrópico 5/imunologia , Adulto , Autoanticorpos/sangue , Autoanticorpos/líquido cefalorraquidiano , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Encefalite Límbica/sangue , Encefalite Límbica/líquido cefalorraquidiano , Encefalite Límbica/complicações , Encefalite Límbica/tratamento farmacológico , Encefalite Límbica/terapia , Metilprednisolona/uso terapêutico , Troca Plasmática , Prosopagnosia/sangue , Prosopagnosia/líquido cefalorraquidiano , Prosopagnosia/complicações , Prosopagnosia/terapia , Receptor de Glutamato Metabotrópico 5/efeitos dos fármacosRESUMO
A 20-year-old woman suffered from anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and was treated with removal of an ovarian teratoma and retroperitoneal ganglioneuroma in addition to immunotherapy. She was incapable of face recognition, had difficulty with object recognition, and lacked color sensation and stereo perception during recovery. These symptoms were transient and completely resolved over 4 months. Our report documents additional aspects of visual impairment associated with anti-NMDAR encephalitis and suggests that the disease can lead to diffuse cerebral dysfunction including the cortical visual system.