I Can't Remember: A Cheerleader With Acute Memory Loss

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I Can't Remember: A Cheerleader With Acute Memory Loss - Page #3

Lab Studies: CBC: Hemoglobin 9.5, iron studies showed iron deficiency Metabolic: CMP, TSH, pregnancy test, urinalysis, Vitamin B1, Vitamin B9, Vitamin B12, Creatine Kinase, Lactate Dehydrogenase, Ammonia, Acetyl Carotene, urine organic acids, and pyruvic acid studies were unremarkable Sexually Transmitted Infections: HIV, Syphilis, Gonorrhea, and Chlamydia testing was negative Autoimmune: Erythrocyte Sedimentation Rate, C-reactive Protein, ANA, and Sjogren's antibody testing was unremarkable CSF Studies: Lymphocytes present, NMDA-receptor antibody negative, Autoimmune Encephalopathy panel positive for anti-GAD65 antibodies Other Studies: CT Head Case Photo #1 , CT Head/Neck Case Photo #2 , Brain MRI [Photo3] and CT Chest Case Photo #4 were all normal. CT Abdomen/Pelvis Case Photo #5 revealed an 8 cm cystic structure in the left adnexa but was otherwise unremarkable. Long term electroencephalography (EEG) demonstrated 60+ subclinical focal seizures emanating from the bilateral (left more than right) temporal regions in less than 24 hours. Repeat Long term EEG after starting 3 anti-epileptic medications showed that she continued to have 40+ subclinical focal seizures per day, originating from the left temporal region. Consultations: Neurology was consulted on admission due to the worsening mentation. Hematology/oncology was later consulted for the iron deficiency anemia and recommendations for plasmapheresis. Gynecology was consulted for the ovarian cyst. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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