The case of leukodystrophy with NMDAR-Abs, and small vessel cerebrovascular disease is intriguing since white matter lesions resembling demyelination have been seen recently in paediatric18 and adult patients with NMDAR-Abs,19 and NMDARs are expressed in oligodendrocytes.22 The case of Definite NMDAR encephalitis after anti-TNF therapy for ankylosing spondylitis, a therapy usually associated with CNS demyelinating disease,23 could be related, although this patient had no evidence of demyelination on MRI. The gene discussed is TNF; the disease is cerebral small vessel disease.