A Case of Cerebral Cortical Encephalitis

A 60-year-old previously healthy woman presented with a 2-month history of progressive cognitive decline and behavioral abnormalities, including mutism and purposeless movements. Neurologic examination revealed impaired consciousness, negativistic behavior, and stereotyped orolingual dyskinesias. Brain MRI showed bilateral frontal–parietal and left temporal leptomeningeal hyperintensities on T2-FLAIR and DWI. CSF analysis revealed 28 WBCs/μL (95% lymphocytes), normal protein and glucose, and strongly positive anti-NMDAR antibodies (CSF titer 1:100; serum 1:10). EEG showed moderate diffuse slowing. Infectious panels, oligoclonal bands, and other autoimmune antibodies were negative. Tumor screening showed no malignancy but identified a right adnexal unilocular cyst. Based on imaging, clinical, and immunologic findings, anti-NMDAR encephalitis was diagnosed. The patient was treated with high-dose intravenous methylprednisolone and IVIG, resulting in marked clinical improvement. Follow-up MRI at 3 months showed near-complete resolution of abnormalities, and she achieved full functional recovery by 6 months. Cerebral cortical encephalitis in anti-NMDAR autoimmune encephalitis. See the discussion, including references, in the full case published here: https://interactn.org/2026/03/03/case-57-cerebral-cortical-encephalitis/. Sixiao Liu: writing – original draft and data analysis. Kunqian Ji: writing – review and editing. Wei Wu: supervision. Wei Li: supervision. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.