227 - From Grief to Recovery: The Acute and Rehabilitative Journey of a 60-Year-Old Woman with Seronegative Autoimmune Encephalitis Triggered by Bereavement

Case Diagnosis: Seronegative Autoimmune Encephalitis.

Case Description: A 60-year-old independent female initially presented to acute care one day after her husband passed away. Her symptoms soon included bilateral vision loss, headaches, leg weakness, and agitation. Her physical exam rapidly worsened with increased involuntary movements, markedly decreased verbal output, altered orientation, and restricted ocular movements. Robust neurologic work up revealed a diagnosis of seronegative autoimmune encephalitis, She began appropriate medical treatment then was discharged to inpatient rehabilitation. As her symptoms improved, she began having episodes of loud, tearful crying prompting neuropsychology consultation. Serial evaluation revealed the outbursts were consistent with autoimmune encephalitis and that the likely etiology of the patients presentation was secondary from her preceding stressful life events. At time of discharge, the patient’s functional status improved from max to total assistance for ADLs to partial/moderate assistance for gait and supervision and no assistance for bed mobility tasks.

Discussions: Seronegative autoimmune encephalitis is a complex diagnosis with a variety of clinical presentations. The most physically limiting symptoms for this patient's presentation was her dystonic tremor and rigidity to all four extremities that fluctuated with stimulation, mutism and aphasia, as well as her optic neuritis. Medical management and intensive rehabilitation saw improvement of her movement disorder, speech, and orientation; compensation therapies aided in functional improvement of her only mild vision changes. Improvement in these symptoms revealed significant underlying and ongoing psychologic distress. It is rarely cited, but significant social stressors are noted to be triggers for and etiologies of autoimmune encephalitis. Prompt early recognition and neuropsychological treatment is vital for improved clinical outcome prognosis. In our patients case, her rehabilitation course notably improved with addressing this underlying psychologic stressor.

Conclusions: Rehabilitation clinicians should consider robust neurologic and psychologic evaluation and treatment in conjunction with intensive neuro-rehabilitation therapies to improve long-term rehabilitation outcomes.