LGI1-abs encephalitis

Abstract

Clinical History: A 71-year-old male presented with episodes of confusion and disorientation lasting a few minutes. Clinical examination revealed choreiform movements. The patient had no recent illness, fever, headaches, nausea or vomiting episodes. Blood results and CT brain were normal, therefore, the underlying reason for the confused and disoriented presentation remained unexplained. Imaging Findings: Two MRI Head scans were subsequently performed one month apart. During the first scan, the patient was uncooperative allowing for only the T2 weighted sequences and diffusion weighted imaging to be performed. Bilateral high signal intensity within the caudate nuclei, putamina as well as the globus pallidi were present, right more than left. The affected basal ganglia were slightly swollen. There was no evidence of restricted diffusion in the affected regions. On the second MRI scan performed one month later, bilateral symmetrical swelling and high FLAIR/T2 signal of the hippocampi was present. There was restricted diffusion in both hippocampi. The basal ganglia appeared normal on T2 weighted images with some high signal on T1 weighted imaging in the right basal ganglia and anterior commissure.