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Novel FDG-PET findings in anti-NMDA receptor encephalitis: a case based report

Mohsin Maqbool1, Deanna A Oleske, A H M Huq

  • 1Department of Pediatrics and Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA. drmohsinch@gmail.com

Journal of Child Neurology
|May 21, 2011
PubMed

Insights

This case report details a 15-year-old boy with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Novel fluorodeoxyglucose-positron emission tomography (FDG-PET) findings revealed cerebellar changes, offering new diagnostic insights.

Area of Science:

  • Neurology
  • Immunology
  • Nuclear Medicine

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disorder affecting the central nervous system.
  • Clinical presentation can be diverse, including psychiatric symptoms, seizures, and movement disorders.
  • Standard neuroimaging like MRI may not reveal early or specific abnormalities.

Observation:

  • A previously healthy 15-year-old male presented with acute onset hallucinations, seizures, and rapid mental status decline.
  • Neurological examination revealed nonverbal status and oro-lingual-facial dyskinesias.
  • Initial extensive work-up and serial brain MRI scans were unremarkable.

Findings:

  • Fluorodeoxyglucose-positron emission tomography (FDG-PET) demonstrated initial global hypometabolism with a focal hypermetabolic lesion in the right cerebellar cortex.
  • Quantitative serology confirmed the diagnosis of anti-NMDAR encephalitis.
  • Following treatment with intravenous immunoglobulin, repeat FDG-PET showed overall improvement, with the right cerebellar cortex now exhibiting focal hypometabolism.

Implications:

  • This case highlights the utility of FDG-PET in diagnosing and monitoring anti-NMDAR encephalitis, particularly when MRI is normal.
  • The distinct cerebellar metabolic changes observed represent a novel imaging finding in this condition.
  • These findings may improve early detection and understanding of the pathophysiology of NMDAR encephalitis.

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