Article Figures & Data
Figures
- Fig 1.
A 66-year-old man with autoimmune VGKC epilepsy. Coronal FLAIR at presentation (A), 7-month follow-up (B), and 46-month follow-up (C) demonstrate progression from unilateral increased signal intensity and enlargement of the left hippocampus (A) to left MTS (arrow, B) and finally progression to bilateral MTS (arrows, C).
- Fig 2.
A 25-year-old man with autoimmune VGKC epilepsy. Imaging at presentation demonstrates enlargement and increased signal intensity in the bilateral hippocampi (A) and bilateral amygdalae (B) on coronal FLAIR, with faint ill-defined enhancement (arrowheads) of the hippocampi (C) on coronal contrast-enhanced T1. Follow-up coronal FLAIR imaging (D) at 4 years demonstrates progression to bilateral MTS (arrows).
- Fig 3.
A 60-year-old man with autoimmune VGKC epilepsy. Initial imaging findings (not shown) were normal. At 1-month follow-up, axial diffusion-weighted imaging demonstrates restricted diffusion in the left hippocampus (A), left perisylvian cortex (arrowheads), and right caudate nucleus (arrow, B). Axial FLAIR (C) shows enlargement and increased signal intensity of the left hippocampus, and axial contrast-enhanced T1-weighted image (D) shows faint ill-defined enhancement (arrowheads) in the left hippocampus. Coronal FLAIR (E) 3 years after presentation shows progression to left MTS (arrow).
- Fig 4.
Time to development of MTS from initial MR imaging abnormality.
- Fig 5.
A 74-year-old man with autoimmune VGKC epilepsy. Coronal FSE T2 image (A) shows mild enlargement and increased signal in the right hippocampus. Follow-up coronal FSE T2 (B) at 1 year shows resolution of hyperintense signal and enlargement of the right hippocampus.
Tables
Clinical findings in autoimmune VGKC encephalitis with seizures
Characteristic Data (No.) Patients seropositive for VGKC with seizure with MR imaging No. 42 Age (yr) (mean) 8–79 (53.5) Sex 22 Males (52.4%) Associated tumor (9) (21.4%) Prostate adenocarcinoma 3 Multiple myeloma 2 Colon carcinoma 2 NHL 1 Thymoma 1 Seizure type Partial/partial complex 27 (62.3%) With secondary generalization 3 Tonic-clonic 8 (19%) With status epilepticus 1 Focal motor 5 (11.9%) Subclinical/EEG evidence only 2 (5.8%) Additional neurologic symptoms Cognitive decline/confusion 16 Memory deficits 13 Dizziness 5 Sensory changes/paresthesias 4 Personality changes 3 Visual aura/hallucinations 3 Nausea/vomiting 3 Headache 2 Treatment Immunotherapy 32 (76.2%) IVMP alone 18 (56.3%) IVIG 5 (15.6%) IVMP/plasmapheresis 3 (9.4%) IVMP/IVIG 2 (6.3%) Oral prednisone 2 (6.3%) IVIG/plasmapheresis 1 (3.1%) IV dexamethasone (Decadron) 1 (3.1%) None 10 (23.8%) Note:—EEG indicates electroencephalography; NHL, Non-Hodgkin lymphoma; IVIG, IV immunoglobulin; IVMP, IV methylprednisolone.
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