200 Section - Autoimmune Encephalitis with Unconsciousness: A Case of Awakening Rehabilitation

1. Autoimmune encephalitis

2. Secondary epilepsy.

3. coma.

4. Pulmonary and Urinary tract infection.

5. Moderate anemia.

 

Case Description:

Patient, Female, 80 years, "loss of consciousness accompanied by convulsions for over 4 months." admitted to hospital on Nov 22, 2024.  

On July 15, 2024, the patient experienced convulsions with loss of consciousness. Admission to the ICU, diagnosed to "multiple cerebral infarctions, secondary epilepsy." From July 23 to November 22, transferred 5 different hospitals, the condition fluctuated and worsened.

Treatment Course:

1. Lumbar puncture (Nov 25): GAD65 antibody +, Hu antibody +. The MDT diagnosed to autoimmune encephalitis.

2. First control infections first with antibiotics + intravenous immunoglobulin (IVIG), and corticosteroids + IVIG to control autoimmune inflammation.

3. Promote awakening and improve function with daily PT/OT/ST treatment. Enriched environmental stimulation + median nerve electrical stimulation to promote recovery of consciousness.

4. Dec 20 able to follow instructions for handshaking and nodding, GCS 8 (E4VTM2). Jan 9, 2025, coughing strongly, pneumonia controlled, and tracheotomy tube removed.

Discussions:

1. Be alert to atypical presentations, the stroke cannot explain the coma. 

2. Management of severe multiple infections is challenging, requiring comprehensive HDU management.

3. Early initiation of rehabilitation starting in HDU.

Conclusions: This elderly patient with autoimmune encephalitis was misdiagnosed as a cerebral infarction in the previous six hospitals. The delayed treatment led to multiple infections and loss of consciousness. After a clear diagnosis, significant functional recovery was achieved through immunotherapy combined with rehabilitation, regaining consciousness, extubation, and restoration of communication ability. This suggests that physicians need to enhance their ability to identify neuroimmune diseases, optimize infection treatment strategies, and emphasize comprehensive management throughout the rehabilitation process.