Reader Response: Teaching NeuroImage: Atypical Unilateral Cortical Ribboning in Anti-NMDA Receptor Encephalitis

We read with great interest the report by Chen et al.(1) on unilateral cortical ribboning in a 62-year-old man with NMDA receptor (NMDAR) antibodies. Most patients with NMDAR encephalitis (50%-75%) have no MRI abnormalities or only subtle white matter lesions.(2) By contrast, cortical ribboning is frequently observed in patients with Creutzfeldt-Jakob disease (CJD) and also in those with asymmetric or strictly unilateral presentation.(3) Furthermore, NMDAR antibodies have been reported in the serum of patients with CJD,(4) although not in CSF.(5)

Automated summary

We found the report on unilateral cortical ribboning in a 62-year-old man with NMDA receptor antibodies interesting. Most NMDAR encephalitis patients do not have MRI abnormalities or only have subtle white matter lesions. Cortical ribboning is frequently seen in patients with Creutzfeldt-Jakob disease and those with asymmetric or strictly unilateral presentation. Additionally, NMDAR antibodies have been reported in the serum of patients with CJD, although not in the CSF.