Fig. 4

Ilustrates the potential pathogenesis of anti-NMDAR and MOG biantibody-positive autoimmune encephalitis. When immune cells directly attack oligodendrocytes, immune reconstitution resulting from withdrawal or dosage reduction as well as virus destroy the blood–brain barrier, NMDAR and MOG antigens are exposed and presented by antigen presenting cells, followed by T and B cell activation, leading to the production of anti-NMDAR and MOG double antibodies, resulting in demyelination and NMDAR invagination degradation, and eventually neuronal death