PMC9074690_01
Brain MRI performance. (A-C) The MRI data of patient at two weeks after the symptom onset showed hyperintensity of the left frontal lobe on fluid-atten uated inversion recovery (FLAIR) imaging and T2-weighted imaging (arrows). (D-F) MRI of the brain was repeated at 6 weeks and showed enhancement of the left frontal lobe lesion involved the bilateral optic nerve (arrows) on FLAIR imaging conducted with gadolinium contrast. (G-I) Brain MRI scan performed at three months after initial symptom onset depicted a significant improvement of the imaging abnormality.
fimmu-13-799454-g001.jpg
PMC9074690_01_fimmu-13-799454-g001.jpg
f1
Magnetic Resonance Imaging (MRI) of the brain showed significant hyperintensity of the cortical and subcortical of the left frontal lobe ( Figures 1A-C ). Repeated brain MRI showed enlarged lesion involving the left frontal, orbital gyrus and bilateral optic nerve with substantial contrast enhancement ( Figures 1D-F ). TBA detection, which indicated that the disease was immunological in nature ( Supplementary Figures 1A, B ). The various tests conducted for the paraneoplastic antibodies, rheumatological autoantibodies, blood routine examination, biochemistry, tumor markers, thyroid profile, mycobacteria, treponema pallidum, human cytomegalovirus, and viral serological were all found to be negative ( Supplementary Table 1 ).
(A) Cerebrospinal fluid (CSF) showing the binding to the surface of the cells expressing anti-NMDAR receptors (NMDAR) (1:10) (scale bar 20mum). (B) Myelin oligodendrocyte glycoprotein (MOG) antibodies (1:32) were detected in the CSF (scale bar 100mum). (C) MOG antibodies (1:1) were detected in serum (scale bar 100mm). (D) GFAP antibodies were found negative in the CSF (scale bar 100mm).
fimmu-13-799454-g002.jpg
PMC9074690_01_fimmu-13-799454-g002.jpg
f2
Neurological examination revealed binocular vision loss with only light perception, and lateral visual field was impaired ( Supplementary Figures 2A, B ). Upon search for anti-neural antibodies (to anti-NMDAR, anti-LGI1, anti-CASPR2, anti-AMPAR, anti-GABABR, anti-DPPX, and anti-mGLuR5), NMDAR antibodies (1:10) were found positive in the patient's CSF by cell-based assay (CBA) (Euroimmun, Lubeck, Germany) ( Figure 2A ). We also used CBA (Euroimmun, Lubeck, Germany) to detect CNS demyelinating antibodies (AQP4, MOG, GFAP), MOG antibodies were found positive in CSF (1:32) ( Figure 2B ) and the serum (1:10) ( Figure 2C ), whereas both AQP4 antibody (not shown) and GFAP antibody ( Figure 2D ) were negative.