Periventricular white matter lesion and incomplete MRZ reaction in a male patient with anti-N-methyl-D-aspartate receptor encephalitis presenting with dysphoric mania.
Several findings suggest that there may be an overlap of anti-N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis with neuromyelitis optica spectrum disorders or acute demyelinating encephalomyelitis (ADEM)-like demyelination. We present a case of a patient with anti-NMDAR antibody encephalitis, who on MRI featured a single prominent T2-hyperintensive white matter lesion in the periventricular region, adjacent to the anterior horn of the left lateral ventricle. In view of the lesion location and the cerebrospinal fluid (CSF) findings (incomplete MRZ (measles, rubella and varicella zoster) reaction, lymphocytic pleocytosis, intrathecal IgG and IgM synthesis; absence of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies), the presence of a multiple sclerosis-like immune response was discussed. This case appears to add evidence to the hypothesis of an overlap between anti-NMDAR antibody encephalitis and other inflammatory central nervous system diseases.
Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
Maximilian
M
Gahr
Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
Florian
F
Lauda
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Moritz E
ME
Wigand
Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
Bernhard J
BJ
Connemann
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Angela
A
Rosenbohm
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Hayrettin
H
Tumani
Clinical Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Markus
M
Reindl
Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
Zeljko
Z
Uzelac
Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Jan
J
Lewerenz
D000328:Adult; D000374:Aggression; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology; D059906:Neuroimaging; D009471:Neuromyelitis Optica / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D014765:Viral Vaccines / Q000276:immunology; D066127:White Matter / Q000473:pathology*
C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D007074:Immunoglobulin G; C571326:MOG protein, human; D063308:Myelin-Oligodendrocyte Glycoprotein; D014765:Viral Vaccines