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After the coronavirus disease 2019 (COVID-19) pandemic emerged, the development of vaccines was accelerated. Neurologic complications of COVID-19 vaccination had been reported, which included encephalitis. In this study, we report a very rare case of a female with anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma that would be triggered by BNT162b2 m-RNA COVID-19 vaccination.

Altered mentality associated with hyperammonemia is usually diagnosed in patients with liver disease. Nonhepatic hyperammonemia may be present in critically ill patients or may be caused by high protein diets or certain drugs. Urea cycle disorders (UCDs) rarely present with altered mentality with hyperammonemia in adult patients. An 82-year-old female visited our hospital with complaints of abnormal behavior and confusion. Routine blood tests revealed elevated serum ammonia. Her mentality and serum ammonia level normalized after lactulose enema and she was discharged thereafter. However, she was later re-admitted because of recurrent altered mentality. Amino acid analysis revealed that serum levels of ornithine and glutamine increased significantly, whereas the levels of alanine and glutamic acid increased slightly, and the levels of arginine, lysine, and citrulline were normal, which were probably caused by reduced activity of the mitochondrial ornithine carrier-1. Although our patient was not diagnosed genetically, this case illustrates the under-recognized fact that UCD can occur in a senile age. Clinical suspicion of UCDs in patients with hyperammonemia is critical for early diagnosis and to prevent the significant neurologic sequelae.

Affective disorders are commonly associated with epilepsy. Affective symptoms rarely occur concomitantly with seizure occurrence, which can lead to misdiagnosis. Here, we describe a 69-year-old man who experiencedintermittent manifestations of unpleasant mood and aggressive behavior. He had temporal lobe epilepsy with amygdala enlargement. After successful treatment with an antiepileptic drug, hissymptoms resolved. Additionally, the amygdala enlargement decreased when checked at 5 years after treatment. We discuss the clinical characteristics and differential points of the case.

Aphasic status epilepticus (ASE) is a rare disorder characterized by recurrent aphasia without impairment of other cognitive functions. A 76-year-old woman with chronic kidney disease developed ASE after neglecting peritoneal dialysis. Magnetic resonance imaging failed to demonstrate an appropriate lesion. Electroencephalography demonstrated ictal discharges in the left frontotemporal leads. ASE disappeared after intravenous valproic acid and correction of uremia. This is the first case report of ASE in a patient with acute aggravation of uremia.

Subacute encephalopathy with seizures in chronic alcoholism syndrome is a rare clinical manifestation in patients with chronic alcohol abuse. We report the case of a patient with chronic alcoholism who presented with partial nonconvulsive status epilepticus associated with a thalamic lesion.

Focal motor status epilepticus (FMSE) is often associated non-ketotic hyperglycemia (NKH). There are no previous reports describing FMSE with NKH that was accompanied by an acute cerebral infarction and its long term follow-up result. We describe the case of a patient having focal motor status epilepticus (FMSE) associated with non-ketotic hyperglycemia (NKH) and acute cerebral infarction who later developed recurrent unprovoked seizures. A small acute infarct was observed in the left frontal subcortical area on diffusion-weighted images (DWI). FMSE was initially controlled with short term antiepileptic drugs and strict glucose control. Two years later, recurrent seizures occurred, and long-term antiepileptic drug treatment was administered. DWI should be considered for acute cerebral infarction in patients having FMSE associated with NKH, and careful follow-up should be conducted for such patients.

Vitamin B6 is closely associated with functions of the nervous, immune, and endocrine systems. Its deficiency may result in neurological disorders including convulsions and epileptic encephalopathy. Until today, this has only been reported in infants, children, and critically ill adult patients. We report a case of a 36year-old man with chronic alcoholism who presented with seizures after gastrointestinal disturbance. His seizures persisted even after treatment with antiepileptic drugs, but eventually disappeared after administration of pyridoxine. Hence, vitamin B6 deficiency may cause seizures in adult patients with chronic alcoholism.

Encephalitis is caused by multiple organisms, but rarely by the hepatitis A virus. A 27-year-old man visited our hospital because of fever, altered consciousness, and seizures. On physical exam, a stuporous mentality and neck stiffness were found. On laboratory exam, elevated liver enzymes and cerebrospinal fluid abnormalities, including pleocytosis and elevated protein levels were observed. The hepatitis A virus (HAV) IgM antibody was also detected. We conclude that these findings were compatible with encephalitis associated with HAV and discuss the pathomechanisms.