Top

Published in:

01-06-2012 | Original Communication

Striatal hypermetabolism in limbic encephalitis

Authors: Caroline Rey, Lejla Koric, Eric Guedj, Olivier Felician, Elsa Kaphan, José Boucraut, Mathieu Ceccaldi

Published in: Journal of Neurology | Issue 6/2012

Abstract

Striatal hypermetabolism on 18FDG-PET scan is a neuroradiological finding that has been described in association with autoimmune disorders such as Sydenham chorea, lupus or antiphospholipid syndrome. Here, we report three patients with non-paraneoplastic limbic encephalitis characterized by 18FDG-PET hypermetabolism of both striata, in contrast with diffuse hypometabolism in the rest of the brain. All patients developed subacute dementia, and antibodies to voltage-gated potassium channels were found in all cases. Brain metabolism and neurological status improved within a few months of immunosuppressive therapy. The finding of striatal hypermetabolism on 18FDG-PET images could thus be highly indicative of limbic encephalitis associated with anti-neuropil antibodies. It could be of significant help in the diagnosis of this rare and treatable condition, and may also provide a useful marker of disease outcome.

Corsellis JA, Goldberg GJ, Norton AR (1968) “Limbic encephalitis” and its association with carcinoma. Brain 91(3):481–496PubMedCrossRef

Bataller L, Kleopa KA, Wu GF et al (2007) Autoimmune limbic encephalitis in 39 patients: immunophenotypes and outcomes. J Neurol Neurosurg Psychiatry 78(4):381–385PubMedCrossRef

Buckley C, Oger J, Clover L et al (2001) Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neurol 50(1):73–78PubMedCrossRef

Sansing LH, Tüzün E, Ko MW et al (2007) A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol 3(5):291–296PubMedCrossRef

Bataller L, Galiano R, García-Escrig M et al (2010) Reversible paraneoplastic limbic encephalitis associated with antibodies to the AMPA receptor. Neurology 74(3):265–267PubMedCrossRef

Vincent A, Buckley C, Schott JM et al (2004) Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 127(3):701–712PubMedCrossRef

Lancaster E, Lai M, Peng X et al (2010) Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol 9(1):67–76PubMedCrossRef

Titulaer MJ, Soffietti R, Dalmau J et al (2011) Screening for tumours in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol 18(1):19 e3PubMedCrossRef

Bartenstein P, Asenbaum S, Catafau A et al (2002) European Association of Nuclear Medicine. European Association of Nuclear Medicine procedure guidelines for brain imaging using [(18)F]FDG. Eur J Nucl Med Mol Imaging 29:43–48

10.

Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state—a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198PubMedCrossRef

11.

Fauser S, Talazko J, Wagner K et al (2005) FDG-PET and MRI in potassium channel antibody-associated non-paraneoplastic limbic encephalitis: correlation with clinical course and neuropsychology. Acta Neurol Scand 111(5):338–343PubMedCrossRef

12.

Ances BM, Vitaliani R, Taylor RA et al (2005) Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 128(8):1764–1777PubMedCrossRef

13.

Chatzikonstantinou A, Szabo K, Ottomeyer C et al (2009) Successive affection of bilateral temporomesial structures in a case of non-paraneoplastic limbic encephalitis demonstrated by serial MRI and FDG-PET. J Neurol 256(10):1753–1755PubMedCrossRef

14.

Scheid R, Lincke T, Volltz R et al (2004) Serial 18F-Fluoro-2-deoxy-d-glucose positron emission tomography and magnetic resonance imaging of paraneoplastic limbic encephalitis. Arch Neurol Nov 61(11):1785–1789CrossRef

15.

Goldman S, Amrom D, Szliwowski HB (1993) Reversible striatal hypermetabolismin a case of Sydenham’s chorea. Mov Disord 8(3):355–358PubMedCrossRef

16.

Furie R, Ishikawa T, Dhawan V et al (1994) Alternating hemichorea in primary antiphospholipid syndrome: evidence for contralateral striatal hypermetabolism. Neurology 44(11):2197–2199PubMedCrossRef

17.

Krakauer M, Law I (2009) FDG PET brain imaging in neuropsychiatric systemic lupus erythematosis with choreic symptoms. Clin Nucl Med 34(2):122–123PubMedCrossRef

18.

Léger GC, Johnson N, Horowitz SW et al (2004) Dementia-like presentation of striatal hypermetabolic state with antistriatal antibodies responsive to steroids. Arch Neurol 61(5):754–757PubMedCrossRef

19.

Kramer EL, Sanger JJ (1990) Brain imaging in acquired immunodeficiency syndrome dementia complex. Semin Nucl Med 20(4):353–363PubMedCrossRef

20.

Rottenberg DA, Sidtis JJ, Strother SC et al (1996) Abnormal cerebral glucose metabolism in HIV-1 seropositive subjects with and without dementia. J Nucl Med 37(7):1133–1141PubMed

21.

von Giesen HJ, Antke C, Hefter H et al (2000) Potential time course of human immunodeficiency virus type 1-associated minor motor deficits: electrophysiologic and positron emission tomography findings. Arch Neurol 57(11):1601–1607CrossRef

22.

Sathekge M, Goethals I, Maes A, van de Wiele C (2009) Positron emission tomography in patients suffering from HIV-1 infection. Eur J Nucl Med Mol Imaging 36(7):1176–1184PubMedCrossRef

23.

Ho DD, Bredesen DE, Vinters HV et al (1989) The acquired immunodeficiency syndrome (AIDS) dementia complex. Ann Intern Med 111:400–410PubMed

24.

Vincent A, Lily O, Palace J (1999) Pathogenic autoantibodies to neuronal proteins in neurological disorders. J Neuroimmunol 100(1–2):169–180PubMedCrossRef

25.

Irani SR, Michell AW, Lang B et al (2011) Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol 69(5):892–900PubMedCrossRef

26.

Baron JC, Levasseur M, Mazoyer B, Legault-Demare F, Mauguiére F, Pappata S, Jedynak P, Derome P, Cambier J, Tran-Dinh S et al (1992) Thalamocortical diaschisis: positron emission tomography in humans. J Neurol Neurosurg Psychiatry 55(10):935–942

27.

Baron JC, Serdaru M et al (1986) Cortical hypometabolism after a thalamic lesion in man: positron tomography study. Rev Neurol (Paris) 142(4):465–474

28.

Pawlik G, Beil C, Herholtz K et al (1985) Comparative dynamic FDG-PET study of functional deactivation thalamic versus extrathalamus focal ischemic brain lesions. J Cereb Blood Flow Metabol 5(suppl 1):S9–S10

Title: Striatal hypermetabolism in limbic encephalitis
Authors: Caroline Rey
Lejla Koric
Eric Guedj
Olivier Felician
Elsa Kaphan
José Boucraut
Mathieu Ceccaldi
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Journal of Neurology / Issue 6/2012
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-011-6308-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Striatal hypermetabolism in limbic encephalitis

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2012

Associated autoimmune diseases in patients with multifocal motor neuropathy and their family members

Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients

Exacerbation of dementia after the earthquake and tsunami in Japan

Central nervous system (CNS) tumor trends in children in a western Canadian province: a population-based 22-year retrospective study

Impact of low mini-mental status on health outcome up to 5 years after stroke: the Erlangen Stroke Project

Clinical and electrophysiological characteristics of neuropathy associated with Tangier disease