case_images: PMC6848057_01
case_images: Magnetic resonance imaging showed slight, non-specific bifrontal medullary lesions, but was otherwise inconspicuous.
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case_images: F1
case_images: A high-resolution 3 Tesla structural MRI of her brain was normal except for a few slight, non-specific bifrontal white matter lesions (Figure 1).
case_images: The electroencephalography depicted a ss-rhythm, with an intermittently slow wave activity of 6-7/s. The independent component analyses showed a frontocentral topography (component 4, framed) compatible with tiredness.
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case_images: PMC6848057_01_fneur-10-01086-g0002.jpg
case_images: F2
case_images: Independent Component Analysis (ICA) showed a frontocentral topography compatible with tiredness (Figure 2).
case_images: An [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) examination at baseline showed a pronounced relative hypermetabolism of parts of the association cortices and mild relative hypometabolism of the primary cortices, consistent with encephalitis. These metabolic findings markedly improved at follow-up. (Upper panel) Transaxial FDG-PET images at baseline and follow-up. (Middle and lower panel) Metabolic deviations from healthy controls, given as three-dimensional stereotactic surface projections (3D-SSP), color-coded as Z score (middle, relative metabolic increases; lower, relative metabolic decreases). All analyses were performed with Neurostat/3D-SSP [LIT].
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case_images: PMC6848057_01_fneur-10-01086-g0003.jpg
case_images: F3
case_images: An [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) examination showed a pronounced relative hypermetabolism of parts of the association cortices and a relative hypometabolism of the primary cortices, well compatible with encephalitis (Figure 3). Follow-up cognitive testing results were within the normal range (Figure 5), and a follow-up FDG-PET (20 days after starting the steroid pulse) showed considerable improvements of the metabolic findings (Figure 3).
case_images: Twenty-four hours of electrocardiogram showing signs of vegetative dysbalance with intermittent sinus tachycardia during daytime and sinus rhythm with stable frequencies during the night (presented are mean heart rates per minute). HF, heart rate; HFmax, maximum heart rate; HFmin, minimum heart rate.
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case_images: F4
case_images: A long-term electrocardiogram (ECG) showed recurrent sinus tachycardia that stopped at night (Figure 4).
case_images: Neuropsychological test results. t0 testing was performed before treatment, and t1 testing was performed 14 days after the steroid pulse treatment.
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case_images: PMC6848057_01_fneur-10-01086-g0005.jpg
case_images: F5
case_images: Neuropsychological testing showed significant deficits in working memory (Figure 5). Follow-up cognitive testing results were within the normal range (Figure 5), and a follow-up FDG-PET (20 days after starting the steroid pulse) showed considerable improvements of the metabolic findings (Figure 3).