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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(02): 177
DOI: 10.1590/0004-282X20150176
IMAGES IN NEUROLOGY

Early occurrence of brief potentially ictal rhythmic discharges [B(I)RDs], and subsequent emergence of asymmetric extreme delta brush (EDB) in Anti-NMDA receptors encephalitis

Ocorrência precoce de breves, rítmicas e potencialmente ictais descargas [B(I)RDS], e surgimento posterior de assimétrico extremo “delta brush” (EDB) num caso de encefalite Anti-NMDAr
Valmir Passareli
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Sao Paulo SP, Brazil;
2   Hospital Santa Marcelina, Departamento de Neurologia, Sao Paulo SP, Brazil.
,
Lais Medeiros
2   Hospital Santa Marcelina, Departamento de Neurologia, Sao Paulo SP, Brazil.
,
Mateus Simabukuro
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Sao Paulo SP, Brazil;
,
Meire Baldocci
2   Hospital Santa Marcelina, Departamento de Neurologia, Sao Paulo SP, Brazil.
,
Sonia Brucki
2   Hospital Santa Marcelina, Departamento de Neurologia, Sao Paulo SP, Brazil.
,
Maria Sheila Guimarães Rocha
2   Hospital Santa Marcelina, Departamento de Neurologia, Sao Paulo SP, Brazil.
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A 12 years-old boy was admitted in coma without motor deficit, with normal CT scan, CSF with lymphocytosis, and EEG showing B(I)RDS ([Figure A]). Continuous EEG (24 hours) and subsequent serial intermittent EEGs were performed. Seizures were not documented. Patient developed orofacial diskynesia and coreoathetosis movements affecting superior limbs. Later, EEG showed asymmetric EDB pattern ([Figure B]). MRi was unremarkable. After immunotherapy, his level of consciousness improved. Anti-NMDAr antibodies were detected in serum and CSF.

Zoom Image
Figure (A) First electroencephalographic record showing frontocentral (F4, C4 electrodes) burst of rhythmic activity with a frequency of 12-14 Hz, during 06s, a Brief potentially ictal rhythmic discharges - B(I)RDS pattern. (B) EEG eight days after admission, showing asymmetric extreme delta brush (EDB) with delta activity more pronounced in right hemisphere. Parameters were as follows: sensitivity 7 μV/mm, time constant 0.3 s and high-frequency filter 70 Hz.

B(I)RDS were described in critically ill patients, often associated with brain injury and seizures, but no reported in Anti-NMDAr encephalitis[1]. EDB has been described in Anti-NMDAr encephalitis; however, their clinical significance remains to be determined[2].



Publication History

Received: 08 July 2015

Accepted: 02 September 2015

Article published online:
06 September 2023

© 2015. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Yoo JY, Rampal N, Petroff OA, Hirsch LJ, Gaspard N. Brief potentially ictal rhythmic discharges in critically ill adults. JAMA Neurol. 2014;71(4):454-62. doi:10.1001/jamaneurol.2013.6238
  • 2 Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094-100. doi:10.1212/WNL.0b013e3182698cd8