• Xiao-Jin Lu, Ran Li, Yong-Xing Chen, Xian-Kai Xu, and Bao-Lin Shi.
• Department of Neurology, School of Clinical, Weifang Medical University.
• Medicine (Baltimore). 2021 Jun 11; 100 (23): e26241e26241.

RationaleTodd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room.Patient ConcernsWe report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE.DiagnosesCASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE.InterventionThe patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days).OutcomesRemission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 days.LessonsAutoimmune encephalitis (AE) should be considered in cases of late-onset epilepsy following meningioma peritumoral brain edema and resection. A diagnosis of AE should be considered in patients presenting with stroke-like symptoms if the magnetic resonance imaging abnormality does not match a known vascular territory. Early and correct diagnosis is crucial because immunotherapy is usually effective for this disease.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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