Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Subacute Encephalitis associated with Anti-Glutamate receptor antibodies: Serial studies of MRI, 1H-MRS and SPECT

Shiro Yamamoto, M.D.1), Yasumichi Koide, M.D.1)3), Mito Fujiwara, M.D.1), Kenichiro Nakazawa, M.D.2), Yukitoshi Takahashi, M.D.3) and Hitoshi Hara, M.D.1)

1)Cerebrovascular Division, Department of Medicine, Yodogawa Christian Hospital
2)Department of Neurology, Yodogawa Christian Hospital
3)National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders

A 32-year-old man who had experienced fever and a pulsating headache of the right occipital region for a month and a transient left hemianopia and numbness in the left arm two weeks prior to presentation was admitted to our hospital because of a seizure. Fluid-attenuated inversion recovery and diffusion-weighted magnetic resonance imaging (MRI) showed high-intensity signals, without reduction of apparent diffusion coefficient value, in the right temporo-occipital cortices. Proton MR spectroscopy (1H-MRS) indicated a decrease in N-acetyl-aspartate, and single-photon emission CT (SPECT) showed hyperperfusion in the right temporo-occipital territory. An examination of the cerebrospinal fluid showed an elevation of mononuclear cells and the presence of anti-glutamate ε2 receptor antibodies. All abnormalities shown by these imaging techniques were normalized in the clinical course. This report suggests that MRI, 1H-MRS and SPECT studies were useful in understanding the pathogenesis of encephalitis associated with glutamate receptor antibodies.
Full Text of this Article in Japanese PDF (561K)

(CLINICA NEUROL, 48: 196|201, 2008)
key words: encephalitis, anti-glutamate receptor antibodies, MR spectroscopy, single photon emission CT

(Received: 15-Sep-07)