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Extreme delta brushes and BIRDs in the EEG of anti-NMDA-receptor encephalitis
  1. Ahmed Abbas1,
  2. Ashish Garg1,
  3. Rajdeep Jain1,
  4. Gordon Mazibrada2,
  5. Saiju Jacob2
  1. 1Department of Clinical Neurophysiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Ahmed Abbas, Department of Clinical Neurophysiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2GW, UK; ahmed.abbas4{at}nhs.net

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A 23-year-old Caucasian woman presented acutely to the emergency department with mild confusion and recurring stereotyped seizures that comprised a tingling sensation in her right arm and leg, followed by a generalised tonic–clonic seizure. She had been diagnosed with anti-N-methyl D-aspartate (NMDA)-receptor encephalitis 4 years previously, having presented with psychosis and generalised convulsive status epilepticus that required intubation. She had made an excellent recovery with no further symptoms and had been maintained on methotrexate until 3 months previously when it was stopped as she was stable.

MR imaging of the brain was normal. Investigations for malignancy, including whole-body positron emission tomography/CT and transvaginal ultrasound, were normal. She was treated as a relapse with intravenous corticosteroids and plasma exchange. Repeat testing of her NMDA …

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