Autoimmun vermittelte Erkrankungen des ZNS jenseits der MS

Christophe Théo Arendt; Elke Hattingen

doi:10.1055/a-2517-5229

Neurologie up2date, Table of Contents

Neurologie up2date 2025; 08(01): 37-61
DOI: 10.1055/a-2517-5229

Immunvermittelte und erregerbedingte Erkrankungen des ZNS

Autoimmun vermittelte Erkrankungen des ZNS jenseits der MS

Authors

Christophe Théo Arendt
Elke Hattingen

Abstract

All articles of this category

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

Full Text

References

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. Accessed June 04, 2024 at: 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 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59: 499-505
19 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
20 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
21 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
22 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
23 Okuda DT, Kantarci O, Lebrun-Frénay C. et al. Dimethyl Fumarate Delays Multiple Sclerosis in Radiologically Isolated Syndrome. Ann Neurol 2023; 93: 604-614
24 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
25 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
26 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
27 Wingerchuk DM, Hogancamp WF, O’Brien PC. et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999; 53: 1107-1114
28 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
29 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
30 Wingerchuk DM, Banwell B, Bennett JL. et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85: 177-189
31 Wingerchuk DM. Evidence for humoral autoimmunity in neuromyelitis optica. Neurol Res 2006; 28: 348-353
32 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
33 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
34 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
35 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
36 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
37 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
38 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
39 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
40 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
41 Kunchok A, Zekeridou A, McKeon A. Autoimmune glial fibrillary acidic protein astrocytopathy. Curr Opin Neurol 2019; 32: 452-458
42 Wynford-Thomas R, Jacob A, Tomassini V. Neurological update: MOG antibody disease. J Neurol 2019; 266: 1280-1286
43 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
44 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
45 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
46 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
47 Jarius S, Paul F, Aktas O. et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 2018; 15: 134
48 Jarius S, Paul F, Aktas O. et al. MOG-Enzephalomyelitis: Internationale Empfehlungen zu Diagnose und Antikörpertestung. Nervenarzt 2018; 89: 1388-1399
49 Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J Neurol 2014; 261: 17-26
50 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
51 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
52 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
53 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
54 Matthews L, Marasco R, Jenkinson M. et al. Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution. Neurology 2013; 80: 1330-1337
55 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
56 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
57 Matricardi S, Farello G, Savasta S. et al. Understanding Childhood Neuroimmune Diseases of the Central Nervous System. Front Pediatr 2019; 7: 511
58 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
59 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
60 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
61 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
62 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
63 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
64 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
65 Zuccoli G, Panigrahy A, Sreedher G. et al. Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis. Neuroradiology 2014; 56: 679-684
66 Eckstein C, Saidha S, Levy M. A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. J Neurol 2012; 259: 801-816
67 Masdeu JC, Quinto C, Olivera C. et al. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 2000; 54: 1427-1433
68 Given 2nd CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol 2004; 182: 195-199
69 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
70 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
71 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
72 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
73 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
74 Dubey D, Pittock SJ, Kelly CR. et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018; 83: 166-177
75 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
76 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
77 Heine J, Prüss H, Bartsch T. et al. Imaging of autoimmune encephalitis--Relevance for clinical practice and hippocampal function. Neuroscience 2015; 309: 68-83
78 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
79 Alves IS, Coutinho AMN, Vieira APF. et al. Imaging Aspects of the Hippocampus. Radiographics 2022; 42: 822-840
80 Bien CG. Limbic encephalitis as a cause of hippocampal sclerosis in adult-onset mediotemporal lobe epilepsy. J Neuroimmunol 2006; 174: 194-195
81 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
82 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
83 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
84 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
85 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
86 Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am 2008; 18: 53-viii
87 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
88 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
89 Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008; 7: 327-340
90 Rosenfeld MR, Eichen JG, Wade DF. et al. Molecular and clinical diversity in paraneoplastic immunity to Ma proteins. Ann Neurol 2001; 50: 339-348
91 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
92 Fang B, McKeon A, Hinson SR. et al. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Novel Meningoencephalomyelitis. JAMA Neurol 2016; 73: 1297-1307
93 Meinck HM. et al. S1-Leitlinie Stiff-Man-Syndrom. 2017. In: Deutsche Gesellschaft für Neurologie (Hrsg.). Leitlinien für Diagnostik und Therapie in der Neurologie. Accessed July 14, 2024 at: www.dgn.org/leitlinien
94 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
95 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
96 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
97 Gabilondo I, Saiz A, Graus F. et al. Response to immunotherapy in CLIPPERS syndrome. J Neurol 2011; 258: 2090-2092
98 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
99 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
100 Zhang YX, Hu HT, Ding XY. et al. CLIPPERS with diffuse white matter and longitudinally extensive spinal cord involvement. Neurology 2016; 86: 103-105
101 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
102 Tang C, Luan G, Li T. Rasmussen’s encephalitis: mechanisms update and potential therapy target. Ther Adv Chronic Dis 2020; 11: 2040622320971413
103 Varadkar S, Bien CG, Kruse CA. et al. Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol 2014; 13: 195-205
104 Bien CG, Granata T, Antozzi C. et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain 2005; 128: 454-471
105 Jegatheeswaran V, Chan M, Chen YA. MRI Findings of Two Patients With Hashimoto Encephalopathy. Cureus 2021; 13: e15697
106 Pittock SJ, Lennon VA, de Seze J. et al. Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol 2008; 65: 78-83
107 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
108 Lauvsnes MB, Omdal R. Systemic lupus erythematosus, the brain, and anti-NR2 antibodies. J Neurol 2012; 259: 622-629
109 Kelley BP, Corrigan JJ, Patel SC. et al. Neuropsychiatric Lupus with Antibody-Mediated Striatal Encephalitis. AJNR Am J Neuroradiol 2018; 39: 2263-2269
110 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