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November 12, 2019; 93 (20) Resident & Fellow Section

Teaching NeuroImages: 18F-FDG-PET/SPM analysis in 3 different stages from a patient with LGI-1 autoimmune encephalitis

Wei Shan, Xiao Liu, Qun Wang
First published November 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008473
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A 50-year-old woman presented with faciobrachial dystonic seizures for about 50 days during sleeping (figure, A). Initial MRI scan was normal, but FDG-PET showed hypermetabolism in the basal ganglia (BG) and medial temporal lobes (MTLs) (figure, B). Clinical symptoms raised a strong suspicion of LGI-1 autoimmune encephalitis (AE) diagnosis, and LGI-1 antibody titer examination (serum and CSF) confirmed the suspicion.1,2 After relapse, the patient showed a previous PET abnormal pattern.

Figure
Figure 18F-FDG-PET/SPM follow-up study for patient with LGI-1 with faciobrachial dystonic seizures (FBDS)

(A) Sequence of events after the patient’s FBDS symptoms appeared. (B) Representative MRI and 18F-FDG-PET/SPM (p < 0.01) image in 3 different time stages from admission diagnosis, relapse, discharge, and review. BG = basal ganglia; IVIg = IV immunoglobulin; IVMP = IV methylprednisolone; MTL = medial temporal lobe; VPA = valproate.

Early diagnosis of LGI-1 AE is necessary for further treatment.2 Abnormal metabolic changes of PET in BG and MTL appeared earlier than in MRI.

Study funding

This work was supported by the National Key R&D Program of China 2017YFC1307500, Beijing-Tianjin-Hebei Cooperative Basic Research Program H2018206435, Capital Healthy Development Research Funding 2016-1-2011, and Beijing Postdoctoral Research Foundation zz 2019-09 (Wei Shan).

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Teaching slides links.lww.com/WNL/A993

References

  1. 1.↵
    1. Graus F,
    2. Titulaer MJ,
    3. Balu R, et al
    . A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016;15:391–404.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Tüzün E,
    2. Dalmau J
    . Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 2007;13:261–271.
    OpenUrlCrossRefPubMed

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