title: Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature.
abstract: BACKGROUND
  Anti-N-methyl-D-aspartate receptor encephalitis is a severe autoimmune disorder characterized by severe psychiatric symptoms, seizures, decreased consciousness, autonomic dysregulation, and dyskinesias. Multifocal subcortical white matter lesions on fluid-attenuated inversion recovery and diffuse weighted images have rarely been reported in previous literature, and serial magnetic resonance imaging changes after plasma exchange have not been presented before.
  
  
  METHODS
  A previously healthy 24-year-old Chinese woman presented with acute psychiatric symptoms characterized by fear and agitation followed by decreased consciousness, dyskinesias, and seizures. Magnetic resonance imaging revealed hyperintense lesions on fluid-attenuated inversion recovery and diffuse weighted images in bilateral subcortical white matter. Cerebrospinal fluid analysis revealed a mild pleocytosis with lymphocytic predominance. Protein and glucose levels were normal. Aquaporin-4 antibodies in serum and cerebrospinal fluid were negative. Identification of anti-N-methyl-D-aspartate receptor antibodies in serum and cerebrospinal fluid confirmed the diagnosis of anti-N-methyl-D-aspartate receptor encephalitis. She was initially treated with combined intravenous immunoglobulin and methylprednisolone without improvement. Plasma exchange was then initiated with good response; the patient made a full recovery after several cycles of plasma exchange. Repeat magnetic resonance imaging performed 1 month after plasma exchange showed partial resolution of the hyperintense lesions in bilateral subcortical white matter, and follow-up magnetic resonance imaging 2 months after plasma exchange showed complete resolution.
  
  
  CONCLUSIONS
  Anti-N-methyl-D-aspartate receptor encephalitis may be concomitant with multifocal subcortical white matter lesions. Such lesions may resolve after appropriate immunotherapy.
authors.affiliation: Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. wangrj73@sina.com.
authors.forename: Rui-Jin
authors.initials: RJ
authors.lastname: Wang
authors.affiliation: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. budongchen@sina.com.
authors.forename: Bu-Dong
authors.initials: BD
authors.lastname: Chen
authors.affiliation: Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing, 100050, People's Republic of China. qidong840111@sina.com.
authors.forename: Dong
authors.initials: D
authors.lastname: Qi
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis* / Q000473:pathology; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007167:Immunotherapy; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D012640:Seizures / Q000209:etiology; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D016194:Receptors, N-Methyl-D-Aspartate; D008775:Methylprednisolone