Bi-insular cortical involvement in anti-NMDA-receptor encephalitis - a case report.
BMC Neurol. 2016 Aug 08; 16:130.BN

Abstract

BACKGROUND

Anti-NMDA-receptor encephalitis is an immune-mediated inflammatory disorder of the central nervous system. Brain MRI is unremarkable in at least 50% of patients and highly variable in the remaining patients with signal abnormalities in different brain regions. Only scarce reports exist on other imaging modalities.

CASE PRESENTATION

A 31-year-old woman sub-acutely developed psychosis, behavioural changes, amnesia, alternating states of agitation and mutism, fever and epileptic seizures. Clinically suspected diagnosis of anti-NMDA-receptor encephalitis was confirmed by the detection of anti-NMDA receptor antibodies in CSF and serum. During the acute phase, brain MRI abnormalities were found in both insular cortices and hippocampi, whereas F(18)-FDG-PET showed hypermetabolism bilaterally in insular and prefrontal cortex. After resection of the underlying ovarian teratoma and with multimodal immunotherapy the patient substantially improved reaching a modified Rankin Scale score of 2 after 3 months. At follow-up, both hippocampi were still affected on MRI, whereas insular cortex appeared normal; however, both regions showed prominent glucose hypometabolism.

CONCLUSIONS

Here, we report bi-insular cortical abnormalities on MRI and F(18)-FDG-PET in a patient with anti-NMDA-receptor encephalitis during the acute phase and after clinical improvement.

Links

Publisher Full Text
ncbi.nlm.nih.gov
bmcneurol.biomedcentral.com
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Authors+Show Affiliations

Hegen H
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. harald.hegen@i-med.ac.at.
Uprimny C
Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Grams A
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
Virgolini I
Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Ramberger M
Neuroimmunology Laboratory, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Beer R
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Helbok R
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Pfausler B
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Schmutzhard E
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.

MeSH

AdultAnti-N-Methyl-D-Aspartate Receptor EncephalitisAntibodiesCerebral CortexDiffusion Magnetic Resonance ImagingFemaleFluorodeoxyglucose F18Follow-Up StudiesHippocampusHumansImmunotherapyN-MethylaspartateOvarian NeoplasmsPositron-Emission TomographyPrefrontal CortexTeratomaWhole Body Imaging

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27502387