[Absence of cortical lesions after the first seizure in a patient with anti-myelin oligodendrocyte glycoprotein-associated cortical encephalitis]

Rinsho Shinkeigaku. 2023 Feb 25;63(2):101-104. doi: 10.5692/clinicalneurol.cn-001796. Epub 2023 Jan 31.
[Article in Japanese]

Abstract

A 31-year-old man developed headache and generalized convulsions. At the time of the first seizure, there was no distinct MRI abnormality. He was admitted to the hospital with repeated seizures, left-sided hemiparesis, and left-sided neglect. He had a slight fever, elevated cerebrospinal fluid (CSF) pressure, and increased CSF cell count with predominance of mononuclear cells. A repeat MRI scan on day 8 after the recurrent seizure showed cortical edema in the right cerebral hemisphere on fluid-attenuated inversion recovery (FLAIR), abnormal high signal on DWI, and decreased apparent diffusion coefficient. The patient was diagnosed with aseptic meningoencephalitis and treated with antiviral drugs and methylprednisolone pulse therapy. Serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody was subsequently detected, and prednisolone was added to treat the FLAIR-hyperintense lesions in anti-MOG antibody associated encephalitis with seizures (FLAMES). It is important to identify the clinical picture and typical images of FLAMES to allow early treatment.

Keywords: FLAIR-hyperintense lesions; anti-MOG antibody; headache; seizure; unilateral cerebral cortical encephalitis.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Autoantibodies
  • Encephalitis* / diagnosis
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Myelin-Oligodendrocyte Glycoprotein
  • Oligodendroglia
  • Seizures / complications

Substances

  • Myelin-Oligodendrocyte Glycoprotein
  • Autoantibodies