A DAY IN THE LIFE OF A NEUROCRITICAL CARE TRAINEE A Case of HIV Seroconversion Presenting Similarly to AntiN-methyl-d-aspartate Receptor Encephalitis

Introduction Continuous electroencephalogram (cEEG) monitoring is recommended in patients with acute supratentorial brain injury and altered mental status, such as patients with encephalitis. This practice may help facilitate prompt treatment of non-convulsive seizures and status epilepticus as well as assess the severity of encephalopathy [1]. As more critically ill patients with encephalopathy are being monitored with cEEG, experience is gained in recognizing EEG background patterns that can aid in prognostication, prediction of illness trajectory, and in a few occasions as biomarkers for specific disease processes [1]. Patients with N-methyl-d-aspartate receptor encephalitis (NMDARE) usually present with amnesia, seizures, psychiatric symptoms, dyskinesias, and autonomic dysfunction. Since the discovery of this antibody-mediated encephalitis in 2005 [2, 3], significant advances have been made in the description of the pathophysiology, clinical presentation, biomarkers, and treatment of NMDARE both in children as well as in adults [4, 5]. Approximately 75% of all patients with NMDARE require intensive care support [6] and are usually monitored with cEEG. In 2012, a characteristic EEG pattern of continuous rhythmic to semi-rhythmic delta frequencies with bursts overriding beta activity termed extreme delta brush (EDB) was described [7]. This pattern was termed unique to NMDARE, usually guides to its diagnosis and has been explored as a potential biomarker [7–9]. More recently, EDB has been recognized in a few other disease processes. We present a case of a patient with acute human immunodeficiency virus (HIV) seroconversion and encephalitis whose presenting clinical picture resembled NMDARE including the presence of EDB, highlighting the importance of comprehensive evaluation of a critically ill encephalopathic febrile patient with seizures.