Autoimmun vermittelte Erkrankungen des ZNS jenseits der MS

Autoimmun vermittelte Erkrankungen des ZNS umfassen viele komplexe Krankheitsbilder, die über die MS hinausgehen. Der Artikel beleuchtet seltenere, aber bedeutende Entzündungen der weißen und grauen Hirn- und Rückenmarksubstanz. Dabei werden die Krankheitsmechanismen, spezifischen Autoantikörper und Bildgebungsmuster erläutert, die für eine präzise Diagnose entscheidend sind. Zudem werden Empfehlungen für die Bildgebung und Differenzialdiagnostik gegeben.

Abstract

Autoimmune-mediated diseases of the central nervous system encompass many complex conditions that extend beyond multiple sclerosis. The article highlights rarer but significant inflammations of the white and gray matter of the brain and spinal cord. It explains the disease mechanisms, specific autoantibodies, and imaging patterns that are crucial for an accurate diagnosis. Additionally, recommendations for imaging and differential diagnosis are provided.

Schlüsselwörter

Autoimmunerkrankungen - Neuromyelitis-optica-Spektrum-Erkrankungen - Myelin-Oligodendrozyten-Glykoprotein-Immunoglobulin-G-Antikörper-assoziierte Erkrankungen - akute disseminierte Enzephalomyelitis - autoimmune Enzephalitis

Keywords

autoimmune mediated diseases - neuromyelitis optica spectrum disorder - myelin oligodendrocyte glycoprotein antibody diseases - acute disseminated encephalomyelitis - autoimmune encephalitis

• Literatur

• 1 Hemmer B. et al. Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie, 2023. In: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Zugriff am 04. Juni 2024 unter: www.dgn.org/leitlinien
• 2 Banwell B, Bennett JL, Marignier R. et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol 2023; 22: 268-282
• 3 de Bruijn MAAM, Bruijstens AL, Bastiaansen AEM. et al. Pediatric autoimmune encephalitis: Recognition and diagnosis. Neurol Neuroimmunol Neuroinflamm 2020; 7: e682
• 4 Lopez JA, Denkova M, Ramanathan S. et al. Pathogenesis of autoimmune demyelination: from multiple sclerosis to neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease. Clin Transl Immunology 2021; 10: e1316
• 5 Weidauer S, Arendt CT. Differenzialdiagnose der zervikalen Myelitis. Radiologie up2date 2022; 22: 137-155
• 6 Dalmau J, Graus F. Antibody-Mediated Encephalitis. N Engl J Med 2018; 378: 840-851
• 7 Patel A, Meng Y, Najjar A. et al. Autoimmune Encephalitis: A Physician’s Guide to the Clinical Spectrum Diagnosis and Management. Brain Sci 2022; 12: 1130
• 8 Graus F, Titulaer MJ, Balu R. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15: 391-404
• 9 Duong MT, Rudie JD, Mohan S. Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications. Neuroimaging Clin N Am 2023; 33: 11-41
• 10 Wattjes MP, Ciccarelli O, Reich DS. et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20: 653-670
• 11 Bernasconi A, Cendes F, Theodore WH. et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia 2019; 60: 1054-1068
• 12 Arani A, Schwarz CG, Wiste HJ. et al. Left-Right Intensity Asymmetries Vary Depending on Scanner Model for FLAIR and T1 Weighted MRI Images. J Magn Reson Imaging 2022; 56: 917-927
• 13 Schievelkamp AH, Jurcoane A, Rüber T. et al. Limbic Encephalitis in Patients with Epilepsy-is Quantitative MRI Diagnostic?. Clin Neuroradiol 2019; 29: 623-630
• 14 Hirai T, Korogi Y, Yoshizumi K. et al. Limbic lobe of the human brain: evaluation with turbo fluid-attenuated inversion-recovery MR imaging. Radiology 2000; 215: 470-475
• 15 Bennett JL, Costello F, Chen JJ. et al. Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment. Lancet Neurol 2023; 22: 89-100
• 16 Vidal-Jordana A, Rovira A, Calderon W. et al. Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study. Neurology 2024; 102: e209214
• 17 Filippi M, Rocca MA, Ciccarelli O. et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol 2016; 15: 292-303
• 18 Baumgartner A, Rauer S, Mader I. et al. Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types. J Neurol 2013; 260: 2744-2753
• 19 Abboud H, Probasco JC, Irani S. et al. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management. J Neurol Neurosurg Psychiatry 2021; 92: 757-768
• 20 Lebrun-Frenay C, Kantarci O, Siva A. et al. Radiologically Isolated Syndrome: 10-Year Risk Estimate of a Clinical Event. Ann Neurol 2020; 88: 407-417
• 21 Lebrun-Frénay C, Siva A, Sormani MP. et al. Teriflunomide and Time to Clinical Multiple Sclerosis in Patients With Radiologically Isolated Syndrome: The TERIS Randomized Clinical Trial. JAMA Neurol 2023; 80: 1080-1088
• 22 Okuda DT, Kantarci O, Lebrun-Frénay C. et al. Dimethyl Fumarate Delays Multiple Sclerosis in Radiologically Isolated Syndrome. Ann Neurol 2023; 93: 604-614
• 23 Jarius S, Ruprecht K, Wildemann B. et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation 2012; 9: 142
• 24 Jarius S, Aktas O, Ayzenberg I. et al. Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J Neurol 2023; 270: 3341-3368
• 25 Jiao Y, Fryer JP, Lennon VA. et al. Updated estimate of AQP4-IgG serostatus and disability outcome in neuromyelitis optica. Neurology 2013; 81: 1197-1204
• 26 Wingerchuk DM, Hogancamp WF, O’Brien PC. et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999; 53: 1107-1114
• 27 Palace J, Leite MI, Nairne A. et al. Interferon Beta treatment in neuromyelitis optica: increase in relapses and aquaporin 4 antibody titers. Arch Neurol 2010; 67: 1016-1017
• 28 Kleiter I, Gahlen A, Borisow N. et al. Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses. Ann Neurol 2016; 79: 206-216
• 29 Wingerchuk DM, Banwell B, Bennett JL. et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85: 177-189
• 30 Wingerchuk DM. Evidence for humoral autoimmunity in neuromyelitis optica. Neurol Res 2006; 28: 348-353
• 31 Trebst C, Raab P, Voss EV. et al. Longitudinal extensive transverse myelitis--it’s not all neuromyelitis optica. Nat Rev Neurol 2011; 7: 688-698
• 32 Flanagan EP, Weinshenker BG, Krecke KN. et al. Short myelitis lesions in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders. JAMA Neurol 2015; 72: 81-87
• 33 Zalewsi NL, Morris PP, Weinshenker BG. et al. Ring-enhancing spinal cord lesions in Neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2017; 88: 218-225
• 34 Pekcevik Y, Mitchell CH, Mealy MA. et al. Differentiating neuromyelitis optica from other causes of longitudinally extensive transverse myelitis on spinal magnetic resonance imaging. Mult Scler 2016; 22: 302-311
• 35 Hyun JW, Lee HL, Park J. et al. Brighter spotty lesions on spinal MRI help differentiate AQP4 antibody-positive NMOSD from MOGAD. Mult Scler 2022; 28: 989-992
• 36 Clarke L, Arnett S, Bukhari W. et al. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12: 722237
• 37 Fang W, Zheng Y, Yang F. et al. Short segment myelitis as the initial and only manifestation of aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorders. Ther Adv Neurol Disord 2020; 13: 1756286419898594
• 38 Cortese R, Magnollay L, Tur C. et al. Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. Neurology 2018; 90: e1183-e1190
• 39 Pinto C, Cambron M, Dobai A. et al. Smoldering lesions in MS: if you like it then you should put a rim on it. Neuroradiology 2022; 64: 703-714
• 40 Kunchok A, Zekeridou A, McKeon A. Autoimmune glial fibrillary acidic protein astrocytopathy. Curr Opin Neurol 2019; 32: 452-458
• 41 Wynford-Thomas R, Jacob A, Tomassini V. Neurological update: MOG antibody disease. J Neurol 2019; 266: 1280-1286
• 42 Sechi E, Cacciaguerra L, Chen JJ. et al. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol 2022; 13: 885218
• 43 Cobo-Calvo A, Ruiz A, Rollot F. et al. Clinical Features and Risk of Relapse in Children and Adults with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Ann Neurol 2021; 89: 30-41
• 44 Jarius S, Ruprecht K, Kleiter I. et al. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome. J Neuroinflammation 2016; 13: 280
• 45 Cobo-Calvo A, Sepúlveda M, Rollot F. et al. Evaluation of treatment response in adults with relapsing MOG-Ab-associated disease. J Neuroinflammation 2019; 16: 134
• 46 Jarius S, Paul F, Aktas O. et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 2018; 15: 134
• 47 Jarius S, Paul F, Aktas O. et al. MOG-Enzephalomyelitis: Internationale Empfehlungen zu Diagnose und Antikörpertestung. Nervenarzt 2018; 89: 1388-1399
• 48 Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J Neurol 2014; 261: 17-26
• 49 Liu H, Zhou H, Wang J. et al. Antibodies to myelin oligodendrocyte glycoprotein in chronic relapsing inflammatory optic neuropathy. Br J Ophthalmol 2019; 103: 1423-1428
• 50 Sechi E, Krecke KN, Messina SA. et al. Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders. Neurology 2021; 97: e1097-e1109
• 51 Dubey D, Pittock SJ, Krecke KN. et al. Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol 2019; 76: 301-309
• 52 Jain K, Cherian A, Divya KP. et al. “FLAMES: A novel burning entity in MOG IgG associated disease”. Mult Scler Relat Disord 2021; 49: 102759
• 53 Matthews L, Marasco R, Jenkinson M. et al. Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution. Neurology 2013; 80: 1330-1337
• 54 Jurynczyk M, Geraldes R, Probert F. et al. Distinct brain imaging characteristics of autoantibody-mediated CNS conditions and multiple sclerosis. Brain 2017; 140: 617-627
• 55 Camera V, Holm-Mercer L, Ali AAH. et al. Frequency of New Silent MRI Lesions in Myelin Oligodendrocyte Glycoprotein Antibody Disease and Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder. JAMA Netw Open 2021; 4: e2137833
• 56 Matricardi S, Farello G, Savasta S, Verrotti A. Understanding Childhood Neuroimmune Diseases of the Central Nervous System. Front Pediatr 2019; 7: 511
• 57 Cole J, Evans E, Mwangi M. et al. Acute Disseminated Encephalomyelitis in Children: An Updated Review Based on Current Diagnostic Criteria. Pediatr Neurol 2019; 100: 26-34
• 58 Krupp LB, Tardieu M, Amato MP. et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 2013; 19: 1261-1267
• 59 Ambrosius W, Michalak S, Kozubski W. et al. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Current Insights into the Disease Pathophysiology, Diagnosis and Management. Int J Mol Sci 2020; 22: 100
• 60 Di Pauli F, Mader S, Rostasy K. et al. Temporal dynamics of anti-MOG antibodies in CNS demyelinating diseases. Clin Immunol 2011; 138: 247-254
• 61 López-Chiriboga AS, Majed M, Fryer J. et al. Association of MOG-IgG Serostatus With Relapse After Acute Disseminated Encephalomyelitis and Proposed Diagnostic Criteria for MOG-IgG-Associated Disorders. JAMA Neurol 2018; 75: 1355-1363
• 62 Tardieu M, Banwell B, Wolinsky JS. et al. Consensus definitions for pediatric MS and other demyelinating disorders in childhood. Neurology 2016; 87(9 Suppl 2): S8-S11
• 63 Berzero G, Cortese A, Ravaglia S. et al. Diagnosis and therapy of acute disseminated encephalomyelitis and its variants. Expert Rev Neurother 2016; 16: 83-101
• 64 Zuccoli G, Panigrahy A, Sreedher G. et al. Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis. Neuroradiology 2014; 56: 679-684
• 65 Eckstein C, Saidha S, Levy M. A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. J Neurol 2012; 259: 801-816
• 66 Masdeu JC, Quinto C, Olivera C. et al. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 2000; 54: 1427-1433
• 67 Given 2nd CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol 2004; 182: 195-199
• 68 O’Riordan JI, Gomez-Anson B, Moseley IF. et al. Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease. J Neurol Sci 1999; 167: 132-136
• 69 Banwell B, Ghezzi A, Bar-Or A. et al. Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurol 2007; 6: 887-902
• 70 Yildiz Ö, Pul R, Raab P. et al. Acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome) in a patient with relapse-remitting multiple sclerosis. J Neuroinflammation 2015; 12: 175
• 71 Baumann M, Sahin K, Lechner C. et al. Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein. J Neurol Neurosurg Psychiatry 2015; 86: 265-272
• 72 Nagaratnam SA, Ferdi AC, Leaney J. et al. Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination. BMC Neurol 2022; 22: 54
• 73 Dubey D, Pittock SJ, Kelly CR. et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018; 83: 166-177
• 74 Endres D, Lüngen E, Hasan A. et al. Clinical manifestations and immunomodulatory treatment experiences in psychiatric patients with suspected autoimmune encephalitis: a case series of 91 patients from Germany. Mol Psychiatry 2022; 27: 1479-1489
• 75 Zuliani L, Graus F, Giometto B. et al. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. J Neurol Neurosurg Psychiatry 2012; 83: 638-645
• 76 Heine J, Prüss H, Bartsch T. et al. Imaging of autoimmune encephalitis--Relevance for clinical practice and hippocampal function. Neuroscience 2015; 309: 68-83
• 77 Wagner J, Schoene-Bake JC, Malter MP. et al. Quantitative FLAIR analysis indicates predominant affection of the amygdala in antibody-associated limbic encephalitis. Epilepsia 2013; 54: 1679-1687
• 78 Alves IS, Coutinho AMN, Vieira APF. et al. Imaging Aspects of the Hippocampus. Radiographics 2022; 42: 822-840
• 79 Bien CG. Limbic encephalitis as a cause of hippocampal sclerosis in adult-onset mediotemporal lobe epilepsy. J Neuroimmunol 2006; 174: 194-195
• 80 Dalmau J, Tüzün E, Wu HY. et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61: 25-36
• 81 Malter MP, Frisch C, Schoene-Bake JC. et al. Outcome of limbic encephalitis with VGKC-complex antibodies: relation to antigenic specificity. J Neurol 2014; 261: 1695-1705
• 82 Kuehn JC, Meschede C, Helmstaedter C. et al. Adult-onset temporal lobe epilepsy suspicious for autoimmune pathogenesis: Autoantibody prevalence and clinical correlates. PLoS One 2020; 15: e0241289
• 83 Kelley BP, Patel SC, Marin HL. et al. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. AJNR Am J Neuroradiol 2017; 38: 1070-1078
• 84 Zhang T, Duan Y, Ye J. et al. Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome. AJNR Am J Neuroradiol 2018; 39: 824-829
• 85 Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am 2008; 18: 53-viii
• 86 Titulaer MJ, Höftberger R, Iizuka T. et al. Overlapping demyelinating syndromes and anti–N-methyl-D-aspartate receptor encephalitis. Ann Neurol 2014; 75: 411-428
• 87 Koga M, Kusunoki S, Kaida K. et al. Nationwide survey of patients in Japan with Bickerstaff brainstem encephalitis: epidemiological and clinical characteristics. J Neurol Neurosurg Psychiatry 2012; 83: 1210-1215
• 88 Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008; 7: 327-340
• 89 Rosenfeld MR, Eichen JG, Wade DF. et al. Molecular and clinical diversity in paraneoplastic immunity to Ma proteins. Ann Neurol 2001; 50: 339-348
• 90 Dalmau J, Gleichman AJ, Hughes EG. et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7: 1091-1098
• 91 Fang B, McKeon A, Hinson SR. et al. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Novel Meningoencephalomyelitis. JAMA Neurol 2016; 73: 1297-1307
• 92 Meinck HM. et al. S1-Leitlinie Stiff-Man-Syndrom. 2017. In: Deutsche Gesellschaft für Neurologie (Hrsg.). Leitlinien für Diagnostik und Therapie in der Neurologie. Zugriff am 14. Juli 2024 unter: www.dgn.org/leitlinien
• 93 Martinez-Hernandez E, Ariño H, McKeon A. et al. Clinical and Immunologic Investigations in Patients With Stiff-Person Spectrum Disorder. JAMA Neurol 2016; 73: 714-720
• 94 Orman G, Kralik SF, Desai NK. et al. Can MRI Differentiate between Infectious and Immune-Related Acute Cerebellitis? A Retrospective Imaging Study. AJNR Am J Neuroradiol 2021; 42: 2231-2237
• 95 Ludovichetti R, Nierobisch N, Achangwa NR. et al. The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis. Neuroradiol J 2024; 37: 206-213
• 96 Gabilondo I, Saiz A, Graus F. et al. Response to immunotherapy in CLIPPERS syndrome. J Neurol 2011; 258: 2090-2092
• 97 Tsibonakis A, Theodorou A, Korkolopoulou P. et al. Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids: A Potentially Overlooked Diagnosis. Ann Neurol 2024; 95: 407-409
• 98 Dudesek A, Rimmele F, Tesar S. et al. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders. Clin Exp Immunol 2014; 175: 385-396
• 99 Zhang YX, Hu HT, Ding XY. et al. CLIPPERS with diffuse white matter and longitudinally extensive spinal cord involvement. Neurology 2016; 86: 103-105
• 100 Freua F, Mahler JV, Lima PLGSB. et al. Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS)-Does it Really Exist?. Brain Sci 2023; 13: 1191
• 101 Tang C, Luan G, Li T. Rasmussen’s encephalitis: mechanisms update and potential therapy target. Ther Adv Chronic Dis 2020; 11: 2040622320971413
• 102 Varadkar S, Bien CG, Kruse CA. et al. Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol 2014; 13: 195-205
• 103 Bien CG, Granata T, Antozzi C. et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain 2005; 128: 454-471
• 104 Jegatheeswaran V, Chan M, Chen YA. MRI Findings of Two Patients With Hashimoto Encephalopathy. Cureus 2021; 13: e15697
• 105 Pittock SJ, Lennon VA, de Seze J. et al. Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol 2008; 65: 78-83
• 106 Lyer A, Elsone L, Appleton R. et al. A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica. Autoimmunity 2014; 47: 154-161
• 107 Lauvsnes MB, Omdal R. Systemic lupus erythematosus, the brain, and anti-NR2 antibodies. J Neurol 2012; 259: 622-629
• 108 Kelley BP, Corrigan JJ, Patel SC. et al. Neuropsychiatric Lupus with Antibody-Mediated Striatal Encephalitis. AJNR Am J Neuroradiol 2018; 39: 2263-2269
• 109 Sarwar S, Mohamed AS, Rogers S. et al. Neuropsychiatric Systemic Lupus Erythematosus: A 2021 Update on Diagnosis, Management, and Current Challenges. Cureus 2021; 13: e17969