Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease.
J Neurol Neurosurg Psychiatry. 2012 Jul; 83(7):681-6.JN

Abstract

BACKGROUND

Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported.

METHODS

The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease.

RESULTS

Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery.

CONCLUSIONS

A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function.

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ncbi.nlm.nih.gov
jnnp.bmj.com
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Authors+Show Affiliations

Leypoldt F
Department of Neurology, University Medical Center Eppendorf, Martinistr 52, Hamburg, Germany. f.leypoldt@uke.uni-hamburg.de
Buchert R
No affiliation info available
Kleiter I
No affiliation info available
Marienhagen J
No affiliation info available
Gelderblom M
No affiliation info available
Magnus T
No affiliation info available
Dalmau J
No affiliation info available
Gerloff C
No affiliation info available
Lewerenz J
No affiliation info available

MeSH

AdultAnti-N-Methyl-D-Aspartate Receptor EncephalitisBrainFemaleFluorodeoxyglucose F18Frontal LobeGlucoseHumansMaleNeuroimagingPositron-Emission TomographyRadiopharmaceuticalsRetrospective StudiesTemporal LobeYoung Adult

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22566598