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Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature.
BMC Neurol. 2015 Jul 08; 15:107.BN

Abstract

BACKGROUND

Anti-N-methyl-D-aspartate receptor encephalitis is a severe autoimmune disorder characterized by severe psychiatric symptoms, seizures, decreased consciousness, autonomic dysregulation, and dyskinesias. Multifocal subcortical white matter lesions on fluid-attenuated inversion recovery and diffuse weighted images have rarely been reported in previous literature, and serial magnetic resonance imaging changes after plasma exchange have not been presented before.

CASE PRESENTATION

A previously healthy 24-year-old Chinese woman presented with acute psychiatric symptoms characterized by fear and agitation followed by decreased consciousness, dyskinesias, and seizures. Magnetic resonance imaging revealed hyperintense lesions on fluid-attenuated inversion recovery and diffuse weighted images in bilateral subcortical white matter. Cerebrospinal fluid analysis revealed a mild pleocytosis with lymphocytic predominance. Protein and glucose levels were normal. Aquaporin-4 antibodies in serum and cerebrospinal fluid were negative. Identification of anti-N-methyl-D-aspartate receptor antibodies in serum and cerebrospinal fluid confirmed the diagnosis of anti-N-methyl-D-aspartate receptor encephalitis. She was initially treated with combined intravenous immunoglobulin and methylprednisolone without improvement. Plasma exchange was then initiated with good response; the patient made a full recovery after several cycles of plasma exchange. Repeat magnetic resonance imaging performed 1 month after plasma exchange showed partial resolution of the hyperintense lesions in bilateral subcortical white matter, and follow-up magnetic resonance imaging 2 months after plasma exchange showed complete resolution.

CONCLUSION

Anti-N-methyl-D-aspartate receptor encephalitis may be concomitant with multifocal subcortical white matter lesions. Such lesions may resolve after appropriate immunotherapy.

Authors+Show Affiliations

Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. wangrj73@sina.com.Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. budongchen@sina.com.Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. qidong840111@sina.com.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

26152327

Citation

Wang, Rui-Jin, et al. "Anti-N-methyl-D-aspartate Receptor Encephalitis Concomitant With Multifocal Subcortical White Matter Lesions On Magnetic Resonance Imaging: a Case Report and Review of the Literature." BMC Neurology, vol. 15, 2015, p. 107.
Wang RJ, Chen BD, Qi D. Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature. BMC Neurol. 2015;15:107.
Wang, R. J., Chen, B. D., & Qi, D. (2015). Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature. BMC Neurology, 15, 107. https://doi.org/10.1186/s12883-015-0366-5
Wang RJ, Chen BD, Qi D. Anti-N-methyl-D-aspartate Receptor Encephalitis Concomitant With Multifocal Subcortical White Matter Lesions On Magnetic Resonance Imaging: a Case Report and Review of the Literature. BMC Neurol. 2015 Jul 8;15:107. PubMed PMID: 26152327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature. AU - Wang,Rui-Jin, AU - Chen,Bu-Dong, AU - Qi,Dong, Y1 - 2015/07/08/ PY - 2015/02/07/received PY - 2015/06/28/accepted PY - 2015/7/9/entrez PY - 2015/7/15/pubmed PY - 2016/4/8/medline SP - 107 EP - 107 JF - BMC neurology JO - BMC Neurol VL - 15 N2 - BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis is a severe autoimmune disorder characterized by severe psychiatric symptoms, seizures, decreased consciousness, autonomic dysregulation, and dyskinesias. Multifocal subcortical white matter lesions on fluid-attenuated inversion recovery and diffuse weighted images have rarely been reported in previous literature, and serial magnetic resonance imaging changes after plasma exchange have not been presented before. CASE PRESENTATION: A previously healthy 24-year-old Chinese woman presented with acute psychiatric symptoms characterized by fear and agitation followed by decreased consciousness, dyskinesias, and seizures. Magnetic resonance imaging revealed hyperintense lesions on fluid-attenuated inversion recovery and diffuse weighted images in bilateral subcortical white matter. Cerebrospinal fluid analysis revealed a mild pleocytosis with lymphocytic predominance. Protein and glucose levels were normal. Aquaporin-4 antibodies in serum and cerebrospinal fluid were negative. Identification of anti-N-methyl-D-aspartate receptor antibodies in serum and cerebrospinal fluid confirmed the diagnosis of anti-N-methyl-D-aspartate receptor encephalitis. She was initially treated with combined intravenous immunoglobulin and methylprednisolone without improvement. Plasma exchange was then initiated with good response; the patient made a full recovery after several cycles of plasma exchange. Repeat magnetic resonance imaging performed 1 month after plasma exchange showed partial resolution of the hyperintense lesions in bilateral subcortical white matter, and follow-up magnetic resonance imaging 2 months after plasma exchange showed complete resolution. CONCLUSION: Anti-N-methyl-D-aspartate receptor encephalitis may be concomitant with multifocal subcortical white matter lesions. Such lesions may resolve after appropriate immunotherapy. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/26152327/Anti_N_methyl_D_aspartate_receptor_encephalitis_concomitant_with_multifocal_subcortical_white_matter_lesions_on_magnetic_resonance_imaging:_a_case_report_and_review_of_the_literature_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0366-5 DB - PRIME DP - Unbound Medicine ER -