FDG-PET hyperactivity in basal ganglia correlating with clinical course in anti–NDMA-R antibodies encephalitis
- 1Department of Neurology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
- 2Nuclear Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
- 3Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Correspondence to Dr Malin Maeder-Ingvar, Department of Neurology, Centre Hospitalier Universitaire Vaudois, BH-07, CH-1011 Lausanne, Switzerland;
- Received 27 October 2009
- Revised 17 December 2009
- Accepted 22 December 2009
- Published Online First 28 July 2010
A form of encephalitis associated with anti–N-methyl-d-aspartate receptor (anti–NMDA-R) antibodies has recently been described.1 Reported patients are mainly young women, presenting with severe encephalitis and additional distinctive neurological features. Around 60% have an ovarian teratoma.1 The severe course of the disease does not rule out favourable prognosis. Immunotherapy is advocated1–3 and appears to be associated with improved outcome.
We present a patient with anti–NMDA-R encephalitis and serial [18F]-fluorodeoxyglucose–positron emission tomography (FDG-PET) examinations showing markedly increased activity in the basal ganglia as compared with that in the cortex when extrapyramidal features were prominent, which normalised after improvement of this movement disorder.
A 25-year old woman developed language difficulties, followed by repeated complex-partial seizures with rare secondary generalisations. On admission 3 weeks later (day 0), the patient had developed fluctuating obtundation, mutism and episodic laughter with dysautonomia (bilateral mydriasis, tachycardia and facial flush), catatonia and progressive limb rigidity with plantar flexor response. The findings of an extended etiological workup (blood cell counts; routine serum chemical analysis and cerebrospinal fluid analysis of infectious, inflammatory, metabolic and paraneoplastic parameters) and a body computed tomographic …