Disclosures: Anne Goldring, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 77-year-old male with history of alcohol use disorder presents with subacute neurologic deterioration secondary to Anti-IgLON5 Syndrome.

Case Description: The patient presented reporting weight loss, confusion, frequent falls, and difficulty swallowing, all of which had arisen in the preceding months. As these symptoms worsened, he also developed dysarthria, abnormal sleep behaviors, hallucinations, and involuntary movements. Physical exam was notable for dysarthria, impaired memory, intermittent myoclonic jerks, and ataxia.

Setting: Acute Care Hospital, Inpatient RehabilitationAssessment/

Results: Initial workup included hematologic and metabolic labs, CTA of the head and neck, and brain MRI, which were largely unremarkable. His presentation was thought to be multifactorial from alcohol use and underlying neurodegenerative process, such as Alzheimer’s Disease. However, given marked deterioration within weeks there was concern for a rapidly progressive etiology. Further workup including initial CSF results, video EEG, and malignancy workup were unrevealing. CSF autoimmune panel resulted positive for anti-IgLON5 antibodies. The patient was discharged to acute inpatient rehabilitation (AIR) where he continued to require moderate to maximum assistance with activities of daily living, problem solving, and memory. Despite ongoing work with speech therapy, his dysphagia worsened. The patient required readmission to acute care for seizures, after which he did not return to AIR, as family opted for hospice.

Discussion: Anti-IgLON5 Syndrome is a rare, devastating neurodegenerative autoimmune disease. The clinical spectrum includes disordered sleep, bulbar dysfunction, impaired gait, chorea and cognitive deterioration. Given the rapid progression of these pervasive impairments, patients with Anti-IgLON5 Syndrome lose functional independence in quick succession. Whether or not there is the opportunity for meaningful intervention with rehabilitation depends on the time and severity of diagnosis.

Conclusion: The ability to detect Anti-IgLON5 antibodies has led to increased diagnosis and characterization of this syndrome. More reports are needed in order to identify the resulting functional outcomes of this patient population and their subsequent rehabilitation course.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/disordered-sleep-movement-and-mind-a-classic-presentation-of-the-rare-anti-iglon5-syndrome/