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Clinical Neuropsychiatry > Antibodies > Flashcards

Antibodies Flashcards

1
Q

What are associated neurological disorders with the NMDAR antigen?

A

Post-herpes simplex encephalitis relapse with chorea; paediatric dyskinetic encephalitis lethargica; idiopathic epilepsy; immunotherapy- responsive dementia.

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2
Q

What are associated neurological disorders with the LGI1 antigen?

A

Morvan’s syndrome, NMT, epilepsy, REM sleep behaviour disorder.

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3
Q

What are associated neurological disorders with the CASPR2 antigen?

A

LE, NMT, epilepsy.

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4
Q

What are the main psychiatric features seen in NMDAR antigen encephalitis?

A

Anxiety, agitation, bizarre behaviour, catatonia, delusional or paranoid thoughts, and visual or auditory hallucinations. Also movement disorder, seizures, autonomic instability.

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5
Q

What are the main psychiatric features seen in LGI1 encephalitis?

A

Confusion, hallucinations, depression.

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6
Q

What is the antigen description of the NMDAR antigen?

A

Ligand gated ion channel

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7
Q

What are the main psychiatric features seen in CASPR2 mediated encephalitis?

A

Confusion, hallucinations, agitation, delusions.

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8
Q

Which main encephalopathy syndrome is CASPR2 associated with?

A

Morvan’s syndrome:
rare constellation of neurological symptoms, consisting of peripheral nerve hyperexcitability, autonomic instability

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9
Q

What is encephalitis

A

inflammation of the brain

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10
Q

What is encephalitis divided into?

A

Infectious encephalitis, immune-mediated encephalitis and unknown

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11
Q

what are the causes of encephalitis?

A

Infective, non-infective and unknown

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12
Q

What can infective encephalitis be sub-divided into?

A

Viral, Bacterial, Protozoal, Rickettsial and Fungal

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13
Q

What are some examples of viral encephalitis?

A

HSV-1,HSV-2, HIV, measles, influenza, VZV, CMV, EBV, dengue, rabies, Zika, JC virus

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14
Q

Give examples of bacterial causes

A

syphilis, borrelia (Lyme disease), Mycobacterium tuberculosis

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15
Q

What are examples of protozoal causes

A

malaria, toxoplasma, human African trypanosomiasis (sleeping sickness)

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16
Q

What are examples of non-infective causes

A

Autoimmune
▪ Paraneoplastic: Hu, Ma, ampiphysin, CV2
▪ Non-paraneoplastic: NMDAR, LGI1, CASPR2, DPPX, IgLON5 ▪ Systemic lupus erythematosus
▪ ADEM

17
Q

What are some unknown types

A

Encephalitis lethargica
Rasmussen’s encephalitis

18
Q

What are symptoms of HSV-1

A

headache, fever, seizures and confusion

19
Q

what are the acute psychiatric symptoms of HSV-1?

A

Agitation
Confusion
Psychosis esp hallucinations Mania
Delirium
Confabulation
Catatonia

20
Q

what are the chronic psychiatric symptoms of HSV-1?

A

Cognitive impairment esp anterograde amnesia (25-75%) with variable retrograde component
Executive/frontal dysfunction in 40%
Disinhibition
Aggression
Kluver-Bucy syndrome

21
Q

What are investigation results for NMDAR encephalitis?

A

Serum inflammatory markers usually normal
MRI: 33% abnormal (non-specific)
CSF: 80% abnormal
Lymphocytic pleocytosis 75% Oligoclonal bands 53%
EEG: 80-90% abnormal (inc ‘extreme delta brush’) Malignancy found in 39% (figure decreasing)

22
Q

Briefly what does the anti NMDAR antibody do?

A

target the receptor, internalizing it, causes NMDA receptor hypofunction

23
Q

What are signs of VGKC (voltage-gated potassium channel) encephalitis?

A

Memory deficits, disorientation and medial temporal lobe seizures predominate

24
Q

What is the clinical diagnostic criteria of AE?

A

Diagnosis can be made when all three of the following criteria are met: subacute onset of working memory deficits, altered mental status or psychiatric symptoms.

At least one of the following: new focal CNS findings, seizures not explained by a previously known seizure disorder, CSF pleocytosis and MRI features suggestive of encephalitis.

25
Q

What is the chronic sequelae of encephalitis lethargica?

A

Parkinsonism
Compulsive behaviour
Psychosis
Catatonia

26
Q

What can be used to treat agitation and/or catatonia in encephalitis?

A

Benzodiazepines

27
Q

How does relapse present?

A

More likely to present with isolated psychiatric/ cognitive symptoms

28
Q

What are the main psychiatric symptoms associated with GABA-A?

A

Confusion, anxiety, affective changes (inc depression), hallucinations, catatonia.

29
Q

What are the main psychiatric symptoms associated with GABA-B?

A

Psychosis, agitation, catatonia.

Clinical Neuropsychiatry (15 decks)

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