Longitudinal brain morphology in anti-NMDA receptor encephalitis: a case report with controls

BMC Psychiatry

Mikko Nyman¹  Tuula Ilonen²  Jarmo Hietala²  Iina Isotupa²  Heikki Laurikainen²  Raimo K. R. Salokangas²  Teija Nummelin² 

[1] Department of Emergency Radiology, Turku University Hospital;Department of Psychiatry, University of Turku and Turku University Hospital;

关键词: Anti-N-methyl-D-aspartate receptor encephalitis;    Non-paraneoplastic;    Brain morphometry;   

DOI  :  10.1186/s12888-019-2141-4

来源: DOAJ

【 摘 要 】

Abstract Background Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a severe autoimmune condition, which typically affects young females. The long-term clinical consequences and brain morphology changes after anti-NMDAR encephalitis are not well known. Case presentation We present clinical and neuroimaging follow-up data on a 25-year female patient with typically presenting anti-NMDAR encephalitis. Longitudinal analyses of brain morphology were done using 3 T structural magnetic resonance imaging (sMRI) and Freesurfer analysis at the time of diagnosis and after symptomatic remission. The presented case attained good functional recovery after standard immunoglobulin-corticosteroid treatment but elevated serum NMDAR antibody levels persisted. The patient had no symptomatic relapses during a 3-year clinical follow-up. In the baseline brain sMRI scan there were no marked volume changes. However, a follow-up sMRI after 9 months indicated clear volume reductions in frontal cortical regions compared to matched controls with identical sMRI scans. Conclusions This case report of anti-NMDAR encephalitis suggests that despite clinical recovery long-term brain morphological changes can develop in the frontal cortex. Longer clinical and imaging follow-up studies are needed to see whether these frontocortical alterations are fully reversible and if not, can they result in trait vulnerabilities for e.g. neuropsychiatric disorders.

【 授权许可】

Unknown