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Myelin Oligodendrocyte Glycoprotein Antibody-associated Cerebral Cortical Encephalitis: Two Cases Highlighting

Rin Yagishita1, Kohei Takikawa1, Riku Toba1

  • 1Department of Neurology, Iwate Prefectural Central Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|May 24, 2026
PubMed

Insights

Cerebral cortical encephalitis (CCE), a form of MOG antibody disease, can present unusually. Characteristic MRI findings are key to diagnosing CCE, even with atypical symptoms like seizures or fever.

Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Cerebral cortical encephalitis (CCE) is a specific presentation of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease.
  • Acute encephalitis is the most common clinical manifestation of CCE.

Purpose of the Study:

  • To highlight the diverse clinical presentations of CCE.
  • To emphasize the diagnostic utility of MRI findings in CCE.

Main Methods:

  • Case report analysis of two patients with CCE.
  • Review of clinical courses, diagnostic challenges, and neuroimaging findings.

Main Results:

  • One patient presented with a prolonged, seizure-predominant smoldering course mimicking focal epilepsy.
  • The second patient had nonspecific symptoms of headache and fever without neurological deficits.
  • Both cases exhibited characteristic MRI findings: cortical FLAIR hyperintensity with adjacent subcortical hypointensity.

Conclusions:

  • CCE can exhibit varied clinical courses, challenging initial diagnoses.
  • Characteristic MRI findings are crucial for accurate and timely diagnosis of CCE.
Keywords:
Myelin oligodendrocyte glycoprotein antibody-associated diseaseautoimmune encephalitiscerebral cortical encephalitiscerebrospinal fluidmagnetic resonance imagingseizure

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