PMC6773799_01
Timeline of patient's disease course. (A1) Exemplary axial fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the brain demonstrated leukoencephalopathy but no signs of inflammation. Immune-fluorescence microscopy of anti-NMDA receptor staining with high (B1) and low titers (B2) in serum (depicted) and CSF. Bright green cells represent an antibody-antigen-interaction (B1) while dim cells do not reveal such interaction (B2). CSF, cerebrospinal fluid; MRI, magnetic resonance imaging; MP, methylprednisolone; IA, immunoadsorption-therapy; IG, intravenous immunoglobulins; RTX, rituximab; CP, cyclophosphamide; Anti-NMDA receptor, Anti-N-methyl-D-aspartate receptor.
fneur-10-00987-g0001.jpg
PMC6773799_01_fneur-10-00987-g0001.jpg
F1
Follow-up MRI showed no change (Figure 1, A1) and electroencephalogram (EEG) was unremarkable. IgG. In addition, anti-NMDAR-IgG antibodies in serum (titer 1:200) and CSF (titer 1:100) were found (Figure 1, B1) by using the commercially available cell-based assay of Euroimmune, confirming the diagnosis of anti-NMDAR encephalitis. Follow-up CSF diagnostic 8 weeks after first symptoms and 5 weeks after the first dose of steroids showed decreasing pleocytosis (10 cells/mul, thereof 90% lymphocytes and 10% monocytes) and reduced anti-NMDAR-IgG antibodies titers (1:100 in serum, 1:50 in CSF, Figure 1, B2).