Dr. Keith Roach

DEAR DR. ROACH: My 28-year-old son is in the hospital. He hasn’t been acting like himself for a few weeks (not sleeping nor eating well), and he suddenly had four seizures. The doctors are worried about a condition called autoimmune encephalitis. What can you tell me about it? — J.M.

ANSWER: Encephalitis means inflammation of the brain, which is a rare condition. It can be caused by infections (especially viruses) or autoimmune reactions, including antibody-mediated encephalitis. There are only 2,000 cases per year of antibody-mediated encephalitis in the United States.

Several different antibodies can be responsible, and each attacks a specific protein in the brain. At age 28, the most likely type of antibody causing antibody-mediated encephalitis is anti-NMDAR. With this syndrome, children and young adults often develop psychiatric symptoms including insomnia, abnormal movements, agitation, and sometimes hallucinations or delusions. Seizures are common.

The diagnosis is made by finding the antibody in cerebrospinal fluid after a lumbar puncture (“spinal tap”). Antibodies that are found in the blood are not as reliable. An MRI scan is also done to help confirm the diagnosis and exclude other causes.

Some cases of antibody-mediated encephalitis are associated with tumors. For example, young women with anti-NMDAR encephalitis have ovarian tumors over 50% of the time, while young men only have a tumor 5% to 10% of the time. Removing the tumor is important to improve outcomes because it also removes the trigger for the autoimmune disease.

Treatment is best when begun early and, like with many autoimmune diseases, when it is designed to reduce the immune system’s attacks on the body. This may include corticosteroids like prednisone, immune globulin, plasmapheresis (removing antibodies from the blood), or more powerful immune suppressants. With early treatment, most people do well but may still have residual problems.

DEAR DR. ROACH: I frequently can hear my heart beating as though it is inside my head. I am 82 years old and comparatively healthy, all things considered. When this happens, I hold my nose, close my mouth, and blow very hard, which creates pressure and a forceful popping sound in my ears. This removes the sound of the heartbeat for quite a while. What is happening to me? Is something wrong with my ears? — W.C.G.

ANSWER: Hearing a heartbeat is concerning because there might be an abnormality in the blood vessels near your ear, specifically an aneurysm. Fortunately, this is uncommon, but you should go and get it checked out by your doctor.

When the pressure in the ear is very different from the outside, the eardrum does not move properly, so sounds from the outside are muffled, making internal sounds seem louder. “Clearing” your nose equalizes pressure in the middle ear by forcing open the Eustachian tube. The popping sound is the air pressure equalizing.

I recommend being gentle as you can damage delicate structures in the middle ear by applying so much pressure. Simply yawning (or at least opening the mouth like you are going to yawn) or chewing gum can open the Eustachian tube much more safely.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.