PMC9360609_01
Initial cerebral MRI showed increased signal in the vermis and both bilateral cerebellar hemispheres on FLAIR (A,B) without enhancement on contrast-enhanced T1-weighted sequence (C-F). Repeated MRI showed an increase of FLAIR hyperintensity of cerebellar lesions (G) and progression in size of the vermis lesions (H) with slightly enhanced T1-weighted signals on both axial and sagittal view and obvious cerebellar atrophy (I-L).
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F1
Initial brain MRI was performed and showed hyperintensities in the vermis and bilateral cerebellar hemispheres on fluid-attenuated inversion recovery (FLAIR) without enhancement (Figures 1A-F). Remarkably, repeated cerebral MRI indicated obvious cerebellar atrophy and worsened cerebellar lesions with gadolinium enhancement (Figures 1G-L).
The Homer-3 antibody of serum was positive: the red marker represented Homer-3 antibodies (CBA, indirect immunofluorescence) (x400). The scale bar was 50 mum.
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F2
The further laboratory workup of autoantibodies was notable for positive serum Homer-3 antibodies with a titer of 1:100, whereas the CSF sample was negative by using the indirect immunofluorescence technique (IIFT) employing transfected HEK293 cells (Figure 2).
Case report timeline. CBA, cell-based assay; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging; mRS, modified Rankin Scale; SARA, scale for the assessment and rating of ataxia.
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F3
The case report timeline is presented in Figure 3.