Teaching NeuroImage: Dura Mater Thickening and Enhancement in Anti-NMDAR Encephalitis

A 33-year-old man presented with baryglossia, memory disturbance, and seizures for a month. The workup for infectious and rheumatic disease was negative. Serum and CSF anti-NMDAR antibody were positive. MRI showed cortical and subcortical hyperintensities with adjacent pachymeningeal thickening and enhancement (Figure, A–D). Treatment with immunoglobulin and high-dose methylprednisolone produced significant improvement in the symptoms and resolution of changes on the posttreatment MRI (Figure, E–H).

Figure Neuroimaging (MRI) During the Course of the Disease

FLAIR images (A and B, arrowheads) showed multiple cortical and subcortical hyperintensities with adjacent dura mater thickening and enhancement (C and D, arrows). The FLAIR hyperintensities and dural enhancement improved after treatment (E–H). FLAIR = fluid-attenuated inversion recovery.

The frequently reported abnormalities on MRI in anti-NMDAR encephalitis are leptomeningeal enhancement and T2/FLAIR cortical and subcortical hyperintensities in the temporal lobe, followed by the frontal lobe, periventricular region, and cerebellum, rarely involving the dura mater.1,2

Study Funding

No targeted funding reported.


The authors report no relevant disclosures. Go to for full disclosures.

Appendix Authors



  • Go to for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, Med, MS.

  • Teaching slides

  • Received March 19, 2022.
  • Accepted in final form June 17, 2022.

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