Published online by Cambridge University Press: 03 November 2020
This 72-year-old left-handed woman presented with a 2-year history of worsening cognitive slowness. Her family first noticed she had difficulties multitasking and was slower to respond. She progressively became forgetful and exhibited episodes, some characterized unintelligible speech, while in other she appeared to be in a daze. Her gait slowed down in the last year and she now walked with a stooped posture, dragging her feet. In addition, her family endorsed anosmia and dream enactment behavior during the review of systems. She had been evaluated for a possible autoimmune/paraneoplastic encephalopathy due to the relatively rapid progression of his symptoms. He was found to have elevated titers of voltage-gate potassium channel complex (VGKCC) antibodies (0.08 nmol/L; normal < 0.02). Leucine-rich glioma inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) were negative. Given this finding, he underwent a five-day course of intravenous immunoglobulin (IVIg), without subjective or objective (i.e., cognitive testing) improvement.