Diverse Clinical and Imaging Manifestations of VGKC Associated Limbic Encephalitis: A Case Series

Background: The spectrum of clinical features and brain imaging findings in voltagegated potassium channel (VGKC) associated limbic encephalitis (LE) is evolving.Clinical presentations range from neuropsychiatric manifestations to unconsciousness.The two most common subgroups of VGKC-associated encephalitis are anti-leucinerich glioma-inactivated 1 (LGI1) and anti-contactin-associated protein-like 2 (CASPR2), both of which can lead to LE. VGKC encephalitis typically demonstrates classical MRI findings in the acute phase, including T2/FLAIR hyperintensity in the bilateral temporal lobes.Case Series: We describe four cases of VGKC-associated encephalitis: one with CASPR2 antibodies and three with LGI1 antibodies.All cases presented with atypical clinical features and MRI findings that are less commonly reported in the literature.These atypical features often lead to confusion with other mimickers of autoimmune encephalitis.Conclusion: In developing nations like India, autoimmune encephalitis remains underreported due to a low index of clinical suspicion.A delay in diagnosis and initiation of immunotherapy can lead to severe complications, which may ultimately result in death.Early recognition and treatment are crucial to improve outcomes in VGKC-associated encephalitis.