Skip to main content

Advertisement

Log in

Striatal hypermetabolism in limbic encephalitis

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Striatal hypermetabolism on 18FDG-PET scan is a neuroradiological finding that has been described in association with autoimmune disorders such as Sydenham chorea, lupus or antiphospholipid syndrome. Here, we report three patients with non-paraneoplastic limbic encephalitis characterized by 18FDG-PET hypermetabolism of both striata, in contrast with diffuse hypometabolism in the rest of the brain. All patients developed subacute dementia, and antibodies to voltage-gated potassium channels were found in all cases. Brain metabolism and neurological status improved within a few months of immunosuppressive therapy. The finding of striatal hypermetabolism on 18FDG-PET images could thus be highly indicative of limbic encephalitis associated with anti-neuropil antibodies. It could be of significant help in the diagnosis of this rare and treatable condition, and may also provide a useful marker of disease outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Corsellis JA, Goldberg GJ, Norton AR (1968) “Limbic encephalitis” and its association with carcinoma. Brain 91(3):481–496

    Article  PubMed  CAS  Google Scholar 

  2. Bataller L, Kleopa KA, Wu GF et al (2007) Autoimmune limbic encephalitis in 39 patients: immunophenotypes and outcomes. J Neurol Neurosurg Psychiatry 78(4):381–385

    Article  PubMed  CAS  Google Scholar 

  3. Buckley C, Oger J, Clover L et al (2001) Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neurol 50(1):73–78

    Article  PubMed  CAS  Google Scholar 

  4. Sansing LH, Tüzün E, Ko MW et al (2007) A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol 3(5):291–296

    Article  PubMed  Google Scholar 

  5. Bataller L, Galiano R, García-Escrig M et al (2010) Reversible paraneoplastic limbic encephalitis associated with antibodies to the AMPA receptor. Neurology 74(3):265–267

    Article  PubMed  CAS  Google Scholar 

  6. Vincent A, Buckley C, Schott JM et al (2004) Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 127(3):701–712

    Article  PubMed  Google Scholar 

  7. Lancaster E, Lai M, Peng X et al (2010) Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol 9(1):67–76

    Article  PubMed  CAS  Google Scholar 

  8. Titulaer MJ, Soffietti R, Dalmau J et al (2011) Screening for tumours in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol 18(1):19 e3

    Article  PubMed  Google Scholar 

  9. Bartenstein P, Asenbaum S, Catafau A et al (2002) European Association of Nuclear Medicine. European Association of Nuclear Medicine procedure guidelines for brain imaging using [(18)F]FDG. Eur J Nucl Med Mol Imaging 29:43–48

    Google Scholar 

  10. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state—a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  PubMed  CAS  Google Scholar 

  11. Fauser S, Talazko J, Wagner K et al (2005) FDG-PET and MRI in potassium channel antibody-associated non-paraneoplastic limbic encephalitis: correlation with clinical course and neuropsychology. Acta Neurol Scand 111(5):338–343

    Article  PubMed  CAS  Google Scholar 

  12. Ances BM, Vitaliani R, Taylor RA et al (2005) Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 128(8):1764–1777

    Article  PubMed  Google Scholar 

  13. Chatzikonstantinou A, Szabo K, Ottomeyer C et al (2009) Successive affection of bilateral temporomesial structures in a case of non-paraneoplastic limbic encephalitis demonstrated by serial MRI and FDG-PET. J Neurol 256(10):1753–1755

    Article  PubMed  Google Scholar 

  14. Scheid R, Lincke T, Volltz R et al (2004) Serial 18F-Fluoro-2-deoxy-d-glucose positron emission tomography and magnetic resonance imaging of paraneoplastic limbic encephalitis. Arch Neurol Nov 61(11):1785–1789

    Article  Google Scholar 

  15. Goldman S, Amrom D, Szliwowski HB (1993) Reversible striatal hypermetabolismin a case of Sydenham’s chorea. Mov Disord 8(3):355–358

    Article  PubMed  CAS  Google Scholar 

  16. Furie R, Ishikawa T, Dhawan V et al (1994) Alternating hemichorea in primary antiphospholipid syndrome: evidence for contralateral striatal hypermetabolism. Neurology 44(11):2197–2199

    Article  PubMed  CAS  Google Scholar 

  17. Krakauer M, Law I (2009) FDG PET brain imaging in neuropsychiatric systemic lupus erythematosis with choreic symptoms. Clin Nucl Med 34(2):122–123

    Article  PubMed  Google Scholar 

  18. Léger GC, Johnson N, Horowitz SW et al (2004) Dementia-like presentation of striatal hypermetabolic state with antistriatal antibodies responsive to steroids. Arch Neurol 61(5):754–757

    Article  PubMed  Google Scholar 

  19. Kramer EL, Sanger JJ (1990) Brain imaging in acquired immunodeficiency syndrome dementia complex. Semin Nucl Med 20(4):353–363

    Article  PubMed  CAS  Google Scholar 

  20. Rottenberg DA, Sidtis JJ, Strother SC et al (1996) Abnormal cerebral glucose metabolism in HIV-1 seropositive subjects with and without dementia. J Nucl Med 37(7):1133–1141

    PubMed  CAS  Google Scholar 

  21. von Giesen HJ, Antke C, Hefter H et al (2000) Potential time course of human immunodeficiency virus type 1-associated minor motor deficits: electrophysiologic and positron emission tomography findings. Arch Neurol 57(11):1601–1607

    Article  Google Scholar 

  22. Sathekge M, Goethals I, Maes A, van de Wiele C (2009) Positron emission tomography in patients suffering from HIV-1 infection. Eur J Nucl Med Mol Imaging 36(7):1176–1184

    Article  PubMed  Google Scholar 

  23. Ho DD, Bredesen DE, Vinters HV et al (1989) The acquired immunodeficiency syndrome (AIDS) dementia complex. Ann Intern Med 111:400–410

    PubMed  CAS  Google Scholar 

  24. Vincent A, Lily O, Palace J (1999) Pathogenic autoantibodies to neuronal proteins in neurological disorders. J Neuroimmunol 100(1–2):169–180

    Article  PubMed  CAS  Google Scholar 

  25. Irani SR, Michell AW, Lang B et al (2011) Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol 69(5):892–900

    Article  PubMed  Google Scholar 

  26. Baron JC, Levasseur M, Mazoyer B, Legault-Demare F, Mauguiére F, Pappata S, Jedynak P, Derome P, Cambier J, Tran-Dinh S et al (1992) Thalamocortical diaschisis: positron emission tomography in humans. J Neurol Neurosurg Psychiatry 55(10):935–942

    Google Scholar 

  27. Baron JC, Serdaru M et al (1986) Cortical hypometabolism after a thalamic lesion in man: positron tomography study. Rev Neurol (Paris) 142(4):465–474

    CAS  Google Scholar 

  28. Pawlik G, Beil C, Herholtz K et al (1985) Comparative dynamic FDG-PET study of functional deactivation thalamic versus extrathalamus focal ischemic brain lesions. J Cereb Blood Flow Metabol 5(suppl 1):S9–S10

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lejla Koric.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rey, C., Koric, L., Guedj, E. et al. Striatal hypermetabolism in limbic encephalitis. J Neurol 259, 1106–1110 (2012). https://doi.org/10.1007/s00415-011-6308-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-011-6308-2

Keywords

Navigation