Myelin Oligodendrocyte Glycoprotein Antibody-associated Cerebral Cortical Encephalitis: Two Cases Highlighting Diagnostic Pitfalls

Cerebral cortical encephalitis (CCE) represents a distinct phenotype of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. The most frequent presentation of CCE is acute encephalitis. We describe two cases with diverse clinical courses that posed diagnostic challenges. The cases included a 24-year-old man with a seizure-predominant smoldering course over several months, initially diagnosed with focal epilepsy, and a 27-year-old woman with nonspecific headache and fever without any neurological deficits or seizures. Brain magnetic resonance imaging (MRI) in both cases showed cortical fluid-attenuated inversion recovery hyperintensity with adjacent subcortical hypointensity. CCE may present with diverse clinical courses, and characteristic MRI findings were pivotal for making an accurate diagnosis.