A 17-year-old girl with encephalomyelitis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

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A 17-year-old girl with encephalomyelitis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology

A 17-year-old girl presented with a month of anxiety followed by acute psychosis, catatonia, choreo-athetosis, seizures, autonomic instability, lower extremity spasticity, and hyperreflexia. CSF was positive for the NMDA antibody; additional antibodies and infectious etiologies tested negative. MRI brain was normal. MRI spine revealed symmetric T2 hyperintensities in ventral gray matter (Fig 1). EEG showed extreme delta brush. She received sequentially: IV Ig, methylprednisolone, resection of ovarian teratoma, and plasmapheresis, all without much improvement. Rituximab led to significant improvement. Myelopathy, present on the initial encounter, gradually improved At 3 months, repeat MRI spine and motor exam were normal Zubkov et al Vignette © 2015 American Academy of Neurology

Imaging Zubkov et al © 2015 American Academy of Neurology

A 17-year-old girl with encephalomyelitis NMDA encephalitis with myelopathy is rare Previously reported cases had MRI brain abnormalities at time of abnormal MRI spine 1,2 One prior case mimicked the clinical presentation of NMO 1 Spinal cord gray matter involvement has not been previously reported. Zubkov et al © 2015 American Academy of Neurology