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Subacute cognitive impairment, hyponatremia and mesial temporal lobe lesions: a typical presentation of voltage-gated potassium channel (VGKC) antibody-associated limbic encephalitis.

. Herein, we present a case of VGKC antibody-asso-ciated LE and discuss the main phenotypic and imaging features of this unusual disease.CASE A 50-year-old man presented to our hospital with three months history of progressive personality change, sleep disturbance, memory impairment, visual halluci-nations and seizures. Neurological examination showed disorientation, cognitive impairment (Mini Mental State Examination: 13) and memory dysfunction. Blood tests showed hyponatremia - 130 mmol/L (135-145 mmol/L). Thyroid function, antibodies and serologic tests were normal. Cerebrospinal fluid showed high level of pro-teins (558 mg/dL) and mild lymphocytic pleocytosis. Brain magnetic resonance imaging (MRI) disclosed bi-lateral T2 and FLAIR hyperintensity of mesial temporal lobes (Figure). Cancer investigation resulted negative. VGKC serum level was higher than 650 pmol/L (normal range less than 450 pmol/L). These findings confirmed the diagnosis LE with VGKC antibodies. Methylpred-nisolone was started, with partial improvement. Three weeks later, immunoglobulin 0.4 g/Kg daily for five con-secutive days was initiated. One week after immunoglob-