Autoimmune Limbic Encephalitis: A Review of Clinicoradiological Features and the Challenges of Diagnosis

Ding, Jack B.; Dongas, John; Hu, Kevin; Ding, Mark

doi:10.7759/cureus.17529

Cited by 14 publications

(10 citation statements)

References 73 publications

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“…Yet another crucial future prospect would be a comprehensive review focused at specific neuroimaging studies in understanding neuroinflammatory mechanisms and associated cognitive, structural, as well as brain metabolite changes in autoimmune disorders like autoimmune encephalitis (AE) and autoimmune psychosis (AP) which are associated with mood problems. Inflammation-associated damages in limbic structures including hippocampus, cingulate cortex, temporal lobes, frontal basal regions in these patients causes the presentation of cognitive, mood and behavioral changes ( 182 ). Several reviews have summarized that cognitive deficits including persistent memory impairment in these patients are contributed by inflammation associated hippocampal atrophy ( 183 , 184 ).…”

Section: Future Directionsmentioning

confidence: 99%

Inflammatory Markers in Substance Use and Mood Disorders: A Neuroimaging Perspective

et al. 2022

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Chronic exposure to addictive drugs in substance use disorders and stressors in mood disorders render the brain more vulnerable to inflammation. Inflammation in the brain, or neuroinflammation, is characterized by gliosis, microglial activation, and sustained release of cytokines, chemokines, and pro-inflammatory factors compromising the permeability of the blood-brain barrier. There is increased curiosity in understanding how substance misuse and/or repeated stress exposure affect inflammation and contribute to abnormal neuronal activity, altered neuroplasticity, and impaired cognitive control, which eventually promote compulsive drug-use behaviors and worsen mood disorders. This review will emphasize human imaging studies to explore the link between brain function and peripheral markers of inflammation in substance use disorders and mood disorders.

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Section: Future Directionsmentioning

confidence: 99%

Inflammatory Markers in Substance Use and Mood Disorders: A Neuroimaging Perspective

et al. 2022

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“…The pathophysiological mechanisms and imaging features of autoimmune meningoencephalitis vary (Armangue et al, 2014;Budhram et al, 2019;Ding et al, 2021). Nevertheless, a considerable proportion of cases (39-43%) had unknown etiologies for meningitis in our study.…”

Section: Prominent Cerebral Veins On Esi Have Previously Been Describedmentioning

confidence: 57%

Prominent cerebral veins on susceptibility‐weighted angiography in acute meningoencephalitis

Jung,

Park,

Joo

et al. 2023

Brain and Behavior

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Background and purposeWe have commonly observed prominent cerebral veins on susceptibility‐weighted angiography (SWAN) in acute meningoencephalitis. This study aimed to investigate the clinical significance of these findings.MethodsCerebral veins on SWAN of 98 patients with acute meningoencephalitis diagnosed from February 2016 through October 2020 were classified into three groups according to the degree of venous prominence (mild, 23; moderate, 53; and prominent, 22). Clinical variables and laboratory findings were compared between these groups. The influence of variables on the prediction of prominent cerebral veins was measured by random forest (RF) and gradient boosting machine (GBM).ResultsAs cerebral veins became more prominent, cerebrospinal fluid (CSF) glucose level decreased (69.61 ± 29.05 vs. 59.72 ± 22.57 vs. 48.36 ± 20.29 mg/dL, p = .01) and CSF protein level increased (100.73 ± 82.98 vs. 104.73 ± 70.99 vs. 159.12 ± 118.15 mg/dL, p = .03). The etiology of meningoencephalitis, neurological symptoms, and increased intracranial pressure (ICP) signs differed between groups (p < .05). RF and GBM demonstrated that CSF protein level was the variable with the highest power to predict the prominent cerebral vein (mean decrease in node impurity: 4.19, relative influence: 50.66).ConclusionThe presence of prominent cerebral veins on SWAN in acute meningoencephalitis was significantly associated with a low CSF glucose level and a high CSF protein level, as well as ICP. Thus, the visual grade of the cerebral veins on SWAN may be utilized for the management of patients with acute meningoencephalitis.

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“…In addition, immunotherapy, including high-dose intravenous methylprednisolone pulses and IVIG, alone was insufficient to achieve adequate neurological recovery, and the addition of carboplatin-etoposide chemotherapy was required to improve neurological symptoms proportionate to lung tumor shrinkage. The clinical features of the paraneoplastic syndrome of anti-Hu encephalitis are extremely heterogeneous ( 20 ). In a previous study of 71 patients with anti-Hu-associated paraneoplastic neurological syndrome, among 32 patients whose MRI findings were obtained, only 4 had areas of high intensity in the temporal lobe on T2-weighted imaging, and all of them had limbic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Encephalitis Associated with Anti-N-methyl-D-aspartate Receptor and Anti-Hu Antibodies Successfully Treated with Carboplatin and Etoposide for Small-cell Lung Cancer

et al. 2023

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The coexistence of multiple autoantibodies associated with autoimmune encephalitis (AE) is rare. A 63year-old woman developed psychosis and consciousness disorder. Her cerebrospinal fluid was positive for anti-N-methyl-D-aspartate receptor antibodies, and her serum was positive for anti-Hu antibodies. Enhanced computed tomography revealed a mass in the right pulmonary hilum. AE complicated with small-cell lung cancer was diagnosed. Immunotherapy (steroid therapy and intravenous immunoglobulin) and four courses of carboplatin-etoposide chemotherapy were required to improve her neurological symptoms. When the coexistence of multiple antibodies is detected, despite its rarity, aggressive detection and treatment of any underlying malignancy may be recommended.

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Autoimmune Limbic Encephalitis: A Review of Clinicoradiological Features and the Challenges of Diagnosis

Abstract: Ding et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 14 publications

References 73 publications

Inflammatory Markers in Substance Use and Mood Disorders: A Neuroimaging Perspective

Inflammatory Markers in Substance Use and Mood Disorders: A Neuroimaging Perspective

Prominent cerebral veins on susceptibility‐weighted angiography in acute meningoencephalitis

Autoimmune Encephalitis Associated with Anti-N-methyl-D-aspartate Receptor and Anti-Hu Antibodies Successfully Treated with Carboplatin and Etoposide for Small-cell Lung Cancer

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