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Hypersomnia as presenting symptom of anti-Ma2-associated encephalitis: Case study

Department of Neurology, Hospital Juan Ramón Jiménez, Ronda Norte s/n, 21005 Huelva (I.R.-M., G.S., A.R., C.D.-E.); Department of Neurology, Hospital Clinic, Barcelona (F.G.); Spain

¹ Address correspondence to Iñigo Rojas-Marcos, M.D., Department of Neurology, Hospital Juan Ramón Jiménez, Ronda Norte s/n, 21005 Huelva, Spain (irojasm{at}meditex.es).

We describe a patient who presented with excessive daytime sleepiness (EDS) and was eventually diagnosed with anti-Ma2 encephalitis. Neurological examination disclosed somnolence, left palpebral ptosis, and vertical gaze paresis. A brain MRI showed high signal intensity in the hypothalamus and each hippocampus. Ma2 antibodies were found in the patient's serum, and fiberbronchoscopy disclosed a lung carcinoma. After three months of steroid treatment, the results of the patient's neurological exam became normal. We conclude that anti-Ma2 encephalitis may present with mostly isolated EDS and that it may respond to steroids despite old age and the presence of an untreated lung cancer.

Key Words: anti-Ma2 antibodies • diencephalic encephalitis • excessive daytime sleepiness • hypersomnia • paraneoplastic syndrome