Corticospinal tract hyperintensity in patients with LGI1-antibody encephalitis and other central nervous system disorders with neuroglial antibodies

The frequency of corticospinal tract (CST) T2/FLAIR hyperintensity in disorders with neuroglial antibodies is unclear. Herein, we retrospectively reviewed brain MRIs of 101 LGI1-antibody encephalitis patients, and observed CST hyperintensity in 30/101 (30%). It was mostly bilateral (93%), not associated with upper motor neuron signs/symptoms (7%), and frequently decreased over time (39%). In a systematic review including patients with other neuroglial antibodies, CST hyperintensity was reported in 110 with neuromyelitis optica (94%), myelin oligodendrocyte glycoprotein-associated disease (2%), Ma2-antibody (3%) and GAD65-antibody paraneoplastic neurological syndrome (1%). CST hyperintensity is not an infrequent finding in LGI1-Ab encephalitis and other disorders with neuroglial antibodies. [Display omitted] •Brain MRI corticospinal tract hyperintensity elicits a broad differential diagnosis.•Its overall frequency in brain disorders with neuroglial antibodies is unclear.•It is present in 30% among 101 patients with LGI1-antibody encephalitis.•In the literature it is reported in 110 patients with diverse neuroglial antibodies.•Corticospinal tract hyperintensity is not rare in autoimmune brain disorders.