title: [(18)F]-Fluoro-Deoxy-Glucose Positron Emission Tomography Scan Should Be Obtained Early in Cases of Autoimmune Encephalitis.
abstract: Introduction. Autoimmune encephalitis (AE) is a clinically challenging diagnosis with nonspecific neurological symptoms. Prompt diagnosis is important and often relies on neuroimaging. We present a case series of AE highlighting the importance of an early [(18)F]-fluoro-deoxy-glucose positron emission tomography (FDG-PET) scan. Methods. Retrospective review of seven consecutive cases of autoimmune encephalitis. Results. All patients had both magnetic resonance imaging (MRI) and FDG-PET scans. Initial clinical presentations included altered mental status and/or new onset seizures. Six cases had serum voltage-gated potassium channel (VGKC) antibody and one had serum N-methyl-D-aspartate (NMDA) antibody. MRI of brain showed mesial temporal lobe hyperintensity in five cases of VGKC. The other two patients with VGKC or NMDA AE had restiform body hyperintensity on MRI brain or a normal MRI, respectively. Mesial temporal lobe hypermetabolism was noted in three cases on FDG-PET, despite initial unremarkable MRI. Malignancy workup was negative in all patients. Conclusion. A high index of suspicion for AE should be maintained in patients presenting with cognitive symptoms, seizures, and limbic changes on neuroimaging. In cases with normal initial brain MRI, FDG-PET can be positive. Additionally, extralimbic hyperintensity on MRI may also be observed.
authors: Department of Neurology, University of Missouri, 5 Hospital Drive, CE 540, Columbia, MO 65211, USA.
authors: C R
authors: 0000-0002-9386-7791
authors: CR
authors: Newey
authors: Neurology and Critical Care, Wake Forest University School of Medicine, Reynolds M, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors: A
authors: A
authors: Sarwal
authors: Department of Adult Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195-5245, USA; Epilepsy Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195-5245, USA.
authors: S
authors: S
authors: Hantus