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A 78-year-old male presented with abnormal behavior, which progressed to tonic-clonic seizures in right upper limb and impaired consciousness two weeks later. Initial brain MRI and cerebrospinal fluid findings were normal. However, on the 5th day, diffusion-weighted imaging revealed hyperintense areas in the left basal frontal lobe, striatum, and insular cortex. By the 12th day, T1-weighted imaging demonstrated hyperintensity in the left striatum. The symptoms almost improved before the initiation of immunotherapy. Based on the time-course changes in MRI findings and positive serum leucine-rich glioma-inactivated 1 (LGI1) antibody results, the patient was diagnosed with anti-LGI1 encephalitis. The patient also had basal cell carcinoma. T1 hyperintensity in the basal ganglia is a useful diagnostic feature of anti-LGI1 encephalitis.
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Kita et al. (2025) studied this question.
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