PMC3707142_01
Time course of clinical features and antibody titers in the cerebrospinal fluid (CSF) and serum. Disease onset in 1995-1996 is associated with high N-methyl-d-aspartate receptor (NMDAR) antibody titers in the CSF and serum, intrathecal antibody synthesis (NMDAR-specific antibody index), lymphocytic pleocytosis, and oligoclonal bands (OCB) in the CSF. Fifteen years after recovery from clinical symptoms, NMDAR antibodies persist in the serum and CSF, with an NMDAR-specific antibody index of 57 reflecting intrathecal antibody synthesis. EEG indicates electroencephalography; MRI, magnetic resonance imaging; and PSWC, periodic sharp wave complexes.
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F1
Electroencephalography and CSF revealed abnormal findings (Figure 1). However, the initial clinical presentation was reconsidered and analysis of archived serum and CSF samples obtained at symptom presentation revealed high levels of NMDAR antibodies (Figure 1 and Figure 2), with a calculated antibody-specific index greater than 100 indicating intrathecal synthesis.
Reactivity of the patient's cerebrospinal fluid at disease onset (A and B) and 15 years thereafter (C and D) and a negative control (E and F). Comparisons of the immunofluorescence pattern on hippocampal sections of mouse brain (A, C, and E; original magnification x50) and NR1-transfected cells (B, D, and F; original magnification x200; insets, original magnification x400) are shown.
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F2
However, the initial clinical presentation was reconsidered and analysis of archived serum and CSF samples obtained at symptom presentation revealed high levels of NMDAR antibodies (Figure 1 and Figure 2), with a calculated antibody-specific index greater than 100 indicating intrathecal synthesis.