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Case Reports
. 2019 May 10;19(1):145.
doi: 10.1186/s12888-019-2141-4.

Longitudinal brain morphology in anti-NMDA receptor encephalitis: a case report with controls

Heikki Laurikainen  1   2 , Iina Isotupa  3 , Mikko Nyman  4 , Tuula Ilonen  3 , Teija Nummelin  3 , Raimo K R Salokangas  3 , Jarmo Hietala  3   5
Affiliations
Case Reports

Longitudinal brain morphology in anti-NMDA receptor encephalitis: a case report with controls

Heikki Laurikainen et al. BMC Psychiatry. .

Abstract

Background: Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a severe autoimmune condition, which typically affects young females. The long-term clinical consequences and brain morphology changes after anti-NMDAR encephalitis are not well known.

Case presentation: We present clinical and neuroimaging follow-up data on a 25-year female patient with typically presenting anti-NMDAR encephalitis. Longitudinal analyses of brain morphology were done using 3 T structural magnetic resonance imaging (sMRI) and Freesurfer analysis at the time of diagnosis and after symptomatic remission. The presented case attained good functional recovery after standard immunoglobulin-corticosteroid treatment but elevated serum NMDAR antibody levels persisted. The patient had no symptomatic relapses during a 3-year clinical follow-up. In the baseline brain sMRI scan there were no marked volume changes. However, a follow-up sMRI after 9 months indicated clear volume reductions in frontal cortical regions compared to matched controls with identical sMRI scans.

Conclusions: This case report of anti-NMDAR encephalitis suggests that despite clinical recovery long-term brain morphological changes can develop in the frontal cortex. Longer clinical and imaging follow-up studies are needed to see whether these frontocortical alterations are fully reversible and if not, can they result in trait vulnerabilities for e.g. neuropsychiatric disorders.

Keywords: Anti-N-methyl-D-aspartate receptor encephalitis; Brain morphometry; Non-paraneoplastic.

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Conflict of interest statement

Ethics approval and consent to participate

This work was a part of an ongoing first-episode psychosis study. The study protocol was approved by the Joint Ethical Committee of the University of Turku and the Turku University Central Hospital, and is conducted according to the Declaration of Helsinki. As described in the approved study protocol, the capacity of participants in psychiatric treatment was assessed by a psychiatrist interview after oral and written information of the study was provided. Patients too ill to give informed consent were not approached until the situation had stabilized. Written informed consent was obtained from all human subjects prior to their participating in the study.

Consent for publication

After assessment of capacity for consent by a psychiatrist interview a separate written consent for publishing the case report and individual data was obtained. The participant had fully reviewed and accepted the contents to be published after oral and written information of the case study was provided, and before giving written consent.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Proportional change of cortical region volume from baseline to 9-month follow-up period. The case is denoted by black triangles (▲), while grey dots (●) are reference subjects. The median value of all subjects is denoted by a vertical black line. Error bars represent the upper and lower quartiles. *: cortical volume reduction = 1.42xIQR
See this image and copyright information in PMC

References

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