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Delta brush on EEG: a characteristic EEG finding in autoimmune encephalitis
  1. Shafaq Saleem1,
  2. Sarwar Jamil Siddiqui1,
  3. Faizan Abdullah Qureshi2 and
  4. Dureshahwar Kanwar1
  1. 1Neurology, The Aga Khan University Hospital, Main Campus Karachi, Karachi, Sindh, Pakistan
  2. 2Neurophysiology, The Aga Khan University Hospital, Main Campus Karachi, Karachi, Sindh, Pakistan
  1. Correspondence to Dr Shafaq Saleem; drshafaqsaleem{at}


A woman in her late 20s was admitted via the emergency department in the psychiatric ward with acute-onset behavioural changes and suicidal thoughts in the past 2 weeks. Workup revealed positive N-methyl-D-aspartate (NMDA) receptor antibodies in cerebrospinal fluid and electroencephalogram (EEG) showing a specific pattern of delta brush on bilateral frontal regions. Other investigations were unremarkable. The patient was started on intravenous methylprednisolone 1000 mg for 5 days with oral steroids. She responded on steroids. She has been recommended for workup for teratoma/mediastinal tumours with NMDA receptor encephalitis is an autoimmune disorder predominantly affecting women of childbearing age. Delta brush pattern on EEG is specific for NMDA receptor encephalitis hence can be used as a diagnostic tool. It is advisable to investigate any patient with the presentation of mental deterioration for pathological causes. However, treatment with immunotherapy increases the chance of survival and may prevent cognitive impairment.

  • Clinical neurophysiology
  • Epilepsy and seizures
  • Personality disorders

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  • Contributors Supervised by SJS. The patient was admitted under SJS. This case report was written, drafted and edited by SS. FAQ and DK contributed to article writing. Critical analysis was done by DK. EEG contribution was done by FAQ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.