Figure 2. Clinical details and brain MRI from patient 2 with autoimmune encephalitis and serum myelin oligodendrocyte glycoprotein antibodies.

First cerebral MRI of a 12-year-old boy (Pat 2) with encephalopathy, fever, and ataxia reveals generalized edema of the cerebral cortex and the basal ganglia including the caudate nucleus, putamen, and globus pallidum. The initial examination was superimposed with strong movement artifacts, despite which the cortical edema can still be noted in the shown fluid-attenuated inversion recovery images (A and B). The second MRI of the brain performed 7 days later after treatment with high-dose cortisone and immunoglobulins still showed cortical involvement of the right fronto-temporal lobe (C). In the diffusion-weighted images, “T2-shine-through” (D) but no apparent diffusion coefficient (ADC) signal depression was found. In addition, a single new central pontine lesion was noted in the sagittal T2 images with increased signal intensity in diffusion-weighted imaging and ADC signal depression this time as a sign of cytotoxic injury (E and F) but still without contrast enhancement. In the third MRI of the brain performed 18 days after admission, the central pontine lesion was still present (G and H) associated with ADC depression (not shown).