Published in:
Open Access
01-12-2016 | Case report
Bi-insular cortical involvement in anti-NMDA-receptor encephalitis – a case report
Authors:
Harald Hegen, Christian Uprimny, Astrid Grams, Irene Virgolini, Melanie Ramberger, Ronny Beer, Raimund Helbok, Bettina Pfausler, Erich Schmutzhard
Published in:
BMC Neurology
|
Issue 1/2016
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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 F18-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 F18-FDG-PET in a patient with anti-NMDA-receptor encephalitis during the acute phase and after clinical improvement.