AUTHOR=Zhu Lin , Shang Qunzhu , Zhao Charlie Weige , Dai Shujuan , Wu Qian 

TITLE=Case report: Anti-neurexin-3α-associated autoimmune encephalitis secondary to contrast-induced encephalopathy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1060110

DOI=10.3389/fneur.2023.1060110

ISSN=1664-2295

ABSTRACT=A 54-year-old man complained of episodic stinging in his left eye along with weakness and numbness in his right upper and lower extremities for one month. Neurological examination was negative. MRI showed bilateral paraventricular demyelination. CTA showed significant stenosis of the left internal carotid (60%) and vertebral arteries (70%). He underwent left internal carotid stenting and was intubated during the procedure. After procedure, he did not wake up from anesthesia, and he developed flexion and spasticity of the right arm immediately. Then, he was sent to neurocritical unit (NCU). Anti-seizure treatment was adopted due to recurrent general tonic-clonic seizures. Two days later, brain edema and meningitis appeared in MRI, contrast-induced encephalopathy (CIE) was mainly considered, with support of CSF results. 18 days later, serum anti-neurexin-3α IgG was detected at a dilution of 1:10. Anti-neurexin-3α-associated encephalitis was diagnosed. After using immunoglobulin, steroids, mortimycophenate and cyclophosphamide, the patient was fully recovery 7 months later. Meanwhile anti-Neurexin3α antibody IgG was negative in both CSF and serum. MRI was also normal. Although there have scarcely evidence clarified the relationship of CIE and anti-neurexin-3α-associated encephalitis, we inferred that BBB damaged by CIE may result in anti-neurexin-3α antibody entrance into CSF from serum, which led to autoimmune encephalitis (AIE).