Serial arterial spin labeling MRI in autonomic status epilepticus due to anti-LGI1 encephalitis

Abstract

A 56-year-old man presented with a 1-month history of daily autonomic seizures (tachycardia, diaphoresis, and nausea). Diagnosis of limbic encephalitis was confirmed based on brain MRI findings and anti-LGI1 antibodies found in CSF. Autonomic status epilepticus was diagnosed on a video-EEG study, while arterial spin labeling (ASL) sequences and 18F-FDG-PET (figure 1) showed hyperperfusion/hypermetabolism over the hippocampus and amygdala. Follow-up neuroimaging (figure 2) proved improvement of the findings as the patient responded to treatment. ASL is an imaging technique highly sensitive to changes in regional cerebral blood flow that can help in the evaluation and follow-up of patients with epilepsy.1,2