PMC8690251_01
The result of Brain MRI and Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPAR) antibodies in the serum and cerebrospinal fluid (CSF). (A-D) Brain MRI showed high signal changes on fluid-attenuated inversion recovery sequences predominantly affecting the bilateral medial temporal lobe combined with some parts of the temporal cortex and progressive brain atrophy. (A) At the onset of the disease; (B) Onset for more than 10 months; (C) After 2 weeks of hormone shock therapy; (D) Follow-up for 4 months after discharge. (E-H) Anti-AMPAR1 and Anti-AMPAR2 antibodies in the serum and CSF of the patient were positive, as tested by the CBA method. (E) Anti-AMPAR1 antibodies in CSF; (F) Anti-AMPAR2 antibodies in CSF; (G) Anti-AMPAR1 antibodies in serum; (H) Anti-AMPAR2 antibodies in serum.
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Intracranial infection and acute cerebrovascular disease were suspected, but initial brain MRI (Figure 1A) and lumbar puncture were normal. Repeat brain MRI showed high signal changes on T2 and fluid-attenuated inversion recovery sequences predominantly affecting the bilateral medial temporal lobe combined with some parts of the temporal cortex (Figure 1B). A repeat brain MRI showed the increased signal in temporal lobes had improved and there was atrophy of the medial temporal lobe (Figure 1C). The titer of AMPAR1 is 1:10 in CSF (Figure 1E) and serum (Figure 1G), and the titer of AMPAR2 is 1:100 in CSF (Figure 1F), 1:1000 in serum (Figure 1H). MRI brain 3 weeks after admission showed significant atrophy of bilateral medial temporal lobe and temporal cortex (Figure 1D). Mycophenolate mofetil (3 g/day) was maintained when discharged.
Timeline of the case.
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