case_images: PMC11772160_01
case_images: Anti-NMDAR, MOG and GABABR IgG were detected in patient CSF and serum by indirect immunofluorescence on CBA using unfixed HEK293 cells transfected with plasmids. (A) Fluorescent antibody staining to detect anti-MOG IgG expression in serum after the onset of vision loss. (B) Fluorescent antibody staining of serum anti-MOG IgG and CSF and serum anti-NMDAR and anti-GABABR IgG expression was performed 4 months after recurrent seizures with a range of psychiatric, behavioral cognitive, and language disorder symptoms. (C) Fluorescent antibody staining was used to detect the expression of anti-MOG, anti-NMDAR, and anti-GABABR IgG in CSF and serum at 2 weeks after first-line immunotherapy.
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case_images: Serum central nervous system demyelinating antibodies were tested, which revealing positive anti-MOG IgG [titer 1:32, cell-based assay, (CBA)], ( Figure 1A ) and negative AQP4-IgG. But this time serum anti-MOG IgG was negative ( Figure 1B ). CSF oligoclonal IgG bands were negative. CBA revealed positive anti-NMDAR in CSF (titer 1:1) without any other overlapping antibodies ( Figure 1C ).
case_images: (A, B) On the first admission, FLAIR and DWI sequences showed normal (C, D) On the second admission, FLAIR sequences and Contrast-Enhanced T1-weighted sequences of the patient with a series new symptoms onset revealed swelling temporal lobe and enhanced leptomeningeal of right cerebral hemisphere. (E, F) After the treatment of IVMP and IVIG, FLAIR sequences showed increased intensity in the bilateral hippocampi and mesencephalon, and contrast-enhanced T1-weighted sequences showed patchy linear enhancement in the meninges. (G, H) 18F-DPA714 PET/CT showed higher distribution of 18F-DPA714 in right frontal temporoparietal lobe. (I, J) 18F-FDG PET/CT showed hyper metabolism of fluorodeoxyglucose in right frontal temporoparietal lobe. (K, L) After 1 year follow up, FLAIR and T2-weighted sequences showed reduced lesions in the bilateral hippocampi and mesencephalon compared to before.
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case_images: Brain magnetic resonance imaging (MRI) did not identify any abnormalities ( Figures 2A, B ), and visual evoked potentials (VEP) demonstrated an absence of p100 amplitude in the left optic nerve. GAD65, mGLU5, GlyR, D2R and AQP4 autoantibodies were all negative. General and enhanced MRI scan of brain revealed leptomeningeal enhancement and temporal swelling in the right cerebral hemisphere, ( Figures 2C, D ). Repeated brain MRI with contrast revealed hyperintensity of bilateral hippocampi and mesencephalon on FLAIR sequences And patchy linear enhancement of leptomeninges on contrast-enhanced T1-weighted sequences ( Figures 2E, F ). MP dose decreased. Meanwhile, 18F-FDG PET/CT and 18F-DPA714 PET/CT showed hyper metabolism of glucose and inflammatory infiltrate in the right frontotemporal parietal lobe ( Figures 2G-J ). MRI plain scan of brain showed significant reduction in bilateral hippocampal and mesencephalic lesions ( Figures 2K, L ).
case_images: Timeline of the development of symptoms, key findings from imaging and laboratory tests, diagnosis and treatment.
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case_images: The clinical course for this patient was summarized in  Figure 3 .