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January 01, 2018; 5 (1) ArticleOpen Access

Decreased occipital lobe metabolism by FDG-PET/CT

An anti–NMDA receptor encephalitis biomarker

John C. Probasco, Lilja Solnes, Abhinav Nalluri, Jesse Cohen, Krystyna M. Jones, Elcin Zan, Mehrbod S. Javadi and Arun Venkatesan
First published November 15, 2017, DOI: https://doi.org/10.1212/NXI.0000000000000413
John C. Probasco
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Lilja Solnes
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Abhinav Nalluri
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Jesse Cohen
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Krystyna M. Jones
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Elcin Zan
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Mehrbod S. Javadi
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Arun Venkatesan
From the Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Citation
Decreased occipital lobe metabolism by FDG-PET/CT
John C. Probasco, Lilja Solnes, Abhinav Nalluri, Jesse Cohen, Krystyna M. Jones, Elcin Zan, Mehrbod S. Javadi, Arun Venkatesan
Neurology - Neuroimmunology Neuroinflammation Jan 2018, 5 (1) e413; DOI: 10.1212/NXI.0000000000000413

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    Figure 1 Patients with acute anti–NMDA receptor encephalitis have marked hypometabolism of the visual cortical brain region correlating with the medial occipital lobes

    Initial brain fluorodeoxyglucose (FDG)-PET/CT of 8 patients with anti–NMDA receptor, studied within 12 weeks of symptoms. Composite of hypometabolism three-dimensional sterotactic surface projections (3D-SSP): indigo least abnormal and red most abnormal. FLAIR = fluid-attenuated inversion recovery.

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    Figure 2 Medial occipital lobe (designated by visual cortical brain regions) hypometabolism in anti–NMDA receptor encephalitis

    (A) Boxplots of Z scores for fluorodeoxyglucose (FDG)-avidity for brain regions on dedicated FDG-PET/CT for patients admitted after presenting with 12 weeks or less of symptoms with anti–NMDA receptor and other definite AE. (B) Boxplots of Z scores for FDG-avidity for brain regions on initial dedicated brain FDG-PET/CT for all patients with anti–NMDA receptor encephalitis grouped by the modified Rankin Scale (mRS) at the time of the FDG-PET/CT study. AE = autoimmune encephalitis.

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