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Perfusion Imaging in Autoimmune Encephalitis.

Deepak Vallabhaneni1, Muhammad Atif Naveed2,3, Rajiv Mangla3

  • 1Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.

Case Reports in Radiology
|June 2, 2018
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Summary
This summary is machine-generated.

This case report details a rare instance of autoimmune encephalitis presenting with restricted diffusion and hyperperfusion on CT perfusion. Prompt diagnosis and treatment with plasmapheresis led to significant symptom improvement.

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Area of Science:

  • Neurology
  • Immunology

Background:

  • Encephalitis involves brain inflammation with diverse causes.
  • Autoimmune encephalitis stems from antibodies targeting neuronal components.
  • Standard diagnostics like CSF analysis and MRI may not always be conclusive.

Purpose of the Study:

  • To report a unique case of autoimmune encephalitis.
  • To highlight unusual imaging findings in autoimmune encephalitis.
  • To emphasize the diagnostic utility of CT perfusion and GAD65 antibodies.

Main Methods:

  • Case presentation of a 65-year-old female with altered mental status.
  • Diagnostic workup including infectious etiology testing, brain MRI, and CT perfusion.
  • Treatment with plasmapheresis after failure of empirical therapies.

Main Results:

  • Initial workup for infections was negative; MRI showed restricted diffusion and T2-FLAIR hyperintensity.
  • CT perfusion revealed hyperperfusion in the left parietooccipital gray matter.
  • Patient tested positive for GAD65 antibodies, confirming autoimmune encephalitis, and improved with plasmapheresis.

Conclusions:

  • Autoimmune encephalitis can present with restricted diffusion, an uncommon finding.
  • CT perfusion demonstrated hyperperfusion, a novel observation in this context.
  • This case underscores the importance of considering autoimmune encephalitis in unclear neurological presentations and the efficacy of plasmapheresis.