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Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604....

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Meningitis and Encephalitis Dan Egan, MD Vice Chair Education Columbia
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Page 1: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Meningitis and Encephalitis

Dan Egan, MDVice Chair EducationColumbia

Page 2: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

66K, 23/100K population, Median age 24

Page 3: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

696

Page 4: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 5: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 6: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

87%26%

5%

83%

33% 77%

Page 7: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Fever

AMSStiff Neck

44%

Page 8: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

WBC > 500, LR 15

1000-5000

Page 9: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Lactate 3.5, LR 22.9 (12.6-41.9)

Page 10: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 11: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

www.searchhomeremedy.com

Page 12: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 13: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

2015

Page 14: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Hearing LossShort-term Neurologic SequelaeMortality from Strep pneumo only

Page 15: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 16: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Spring, 2009

20 yo F, college student. Finals week.Confused, trouble concentrating. Right hand twitching. Mild headache.Subjective fever.

Page 17: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

AfebrileNormal examLP:270 WBC40 RBCAcyclovir, Admit

Page 18: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Parenchyma

Page 19: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 20: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

WBC usually <500Glucose NORMALProtein up (<150)RBC with HSV

Page 21: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 22: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

The story continues….

Page 23: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 24: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 25: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Anti-N-methyl-D-aspartate Receptor encephalitis (Anti-NMDAR)

Page 26: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Female:Male = 8:1Ages 8-84

Ovarian tumor 60% of women in childbearing age

Page 27: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Psych sx’s

Neuro sx’sAutonomic dysfunction

TRIAD

Page 28: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

Antibodies in CSF

Page 29: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma
Page 30: Dan Egan, MD Meningitis and Vice Chair Encephalitis...Ann Neurol. 2005 October ; 58(4): 594-604. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

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