PMC9389075_01
(A-C) Brain MRI of the patient at two weeks after the symptom onset showed hyperintensity of the extensive cortex in left cerebral hemisphere on fluid attenuated inversion recovery (FLAIR) imaging and diffusion weighted imaging (DWI) (arrows). (D-F) MRI was repeated at six weeks and showed a significant improvement of the imaging abnormality. (G-I) MRI performed at almost eight months after initial symptom onset depicted no signal abnormalities on FLAIR, DWI and T1-weighted gadolinium-enhanced sequences.
fimmu-13-919125-g001.jpg
PMC9389075_01_fimmu-13-919125-g001.jpg
f1
Brain magnetic resonance imaging (MRI) showed extensive cortical edema in left cerebral hemisphere ( Figures 1A-C ). Electroencephalogram (EEG) showed diffuse sharp-slow wave activity in left frontal and temporal lobes ( Supplementary Figure 1 ). Repeat brain MRI indicated alleviated cortical swelling ( Figures 1D-F ). The follow-up EEG was normal and brain MRI revealed no obvious abnormalities ( Figures 1G-I ).
Immunofluorescence of anti-NMDAR, anti-mGluR5 and MOG antibodies in the patient's cerebrospinal fluid and serum. These antibodies bound on the antigens expressed by the HEK293 cells and visualized by the immunofluorescence of fluorescein on the second antibody. (A) Fluorescent antibody staining for expression of MOG antibody in the serum and CSF of the patient at three weeks after the symptom onset. (B) Fluorescent antibody staining for expression of NMDAR and mGluR5 antibodies in the serum and CSF of the patient at three weeks after the symptom onset. (C) Fluorescent antibody staining for expression of MOG antibody in the serum of the patient at six months after discharge.
fimmu-13-919125-g002.jpg
PMC9389075_01_fimmu-13-919125-g002.jpg
f2
AMPA1, AMPA2, LGI1, CASPR2, GABAB, mGluR1, GAD65, and Neurexin-3alpha) were conducted on a cell based assay (CBA). MOG antibodies were positive in the serum (1:32) and CSF (1:10) ( Figure 2A ). Autoimmune encephalitis panel revealed positivity for serum and CSF mGluR5 antibody (both 1:10) as well as positivity for CSF NMDAR antibody (1:10) ( Figure 2B ). Reexamination of MOG antibody and autoimmune encephalitis panel indicated negativity for serum and CSF mGluR5 and NMDAR antibodies as well as CSF MOG antibody, and that serum MOG antibody titer decreased to 1:10 ( Figure 2C ).
Timeline of our patient with clinical manifestations, relevant results of examinations, diagnosis and interventions.
fimmu-13-919125-g003.jpg
PMC9389075_01_fimmu-13-919125-g003.jpg
f3
The clinical manifestations, important results of examinations, relevant diagnosis and interventions of the patient have been summarized in  Figure 3 .