Autoimmune‐mediated encephalitis and mimics: A neuroimaging review

Liang, Conan; Chu, Eleanor; Kuoy, Edward; Soun, Jennifer E.

doi:10.1111/jon.13060

Cited by 9 publications

(4 citation statements)

References 113 publications

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“…Simultaneously bilateral symmetrical cortical lesions are frequently seen in Creutzfeldt-Jakob disease 29 , seizures 30 , diffuse brain ischaemia-hypoxia 31 , hypoglycaemia 32 , autoimmune encephalitis 33 , herpes simplex encephalitis 34 ,reversible posterior leukoencephalopathy 35 , Wernicke encephalopathy 36 , hyperammonemic encephalopathy 37 . carbon monoxide poisoning 38 , etc.…”

Section: Discussionmentioning

confidence: 99%

MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

Liu,

Wang,

Shi

et al. 2024

Preprint

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Background and Purpose: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is one of the most common maternally inherited mitochondrial diseases. Stroke-like episode affecting the cortical cortex is the hallmark of MELAS, however, it rarely presents as simultaneously bilateral symmetric cortices lesions. Methods: We reported a case of MELAS in a 46-year-old female patient with bilateral symmetric occipital and internal temporal cortices involvements on brain magnetic resonance imaging (MRI). A literature review of MELAS patients and a retrospective analysis were performed. Results: We reported a case of MELAS in a 46-year-old female patient with cortical blindness and cognitive decline as well as status epilepticus. She had a family history of diabetes. Although she denied a history of diabetes, elevated blood glucose was noted after admission and diabetes was diagnosed. Laboratory examination revealed elevated lactate acid and creatine kinase levels in blood. Cranial computed tomography (CT) image demonstrated basal ganglia calcification, as well as subtle decreased attenuation in bilateral symmetric occipital and internal temporal cortices. Brain magnetic resonance imaging (MRI) demonstrated symmetric gyriform hyperintensity in bilateral occipital lobes and internal temporal lobes in both grey and white matter on fluid-attenuated inversion recovery (FLAIR) images with restricted diffusion on diffusion weighted images (DWI). A genetic test revealed a point mutation in the mtDNA(3243A > G) by blood examination. Literature review showed there were 231 eligible patients with MELAS were identified from 212 published papers. Symmetric cortical involvements were seen in 15(6.5%) patients on brain MRI. Conclusions: MELAS should be considered as a potential diagnosis in the patients with bilateral symmetric stroke-like cortices lesions.

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Section: Discussionmentioning

confidence: 99%

MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

Liu,

Wang,

Shi

et al. 2024

Preprint

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“…The most pathognomonic lesion is observed in the medial temporal lobes but can also be found in other areas, including the insular, cingulate, and frontobasal cortices [ 13 ]. These MRI lesions can also be present in ALE [ 14 ], but they are more pathognomonic in HSE.…”

Section: Discussionmentioning

confidence: 99%

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Na,

Lee,

Kim

et al. 2024

encephalitis

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Herpes simplex encephalitis (HSE) is a common viral encephalitis that can be fatal if not adequately treated. Fever, cerebrospinal fluid (CSF) pleocytosis, and typical neuroimaging findings are commonly observed in HSE cases. We encountered a patient with HSE who did not exhibit these classic clinical features. A 63-year-old male presented with his first-ever seizure. Fever did not develop until the fourth day of admission, and neither neuroimaging nor CSF analysis revealed abnormalities. Under suspicion of autoimmune encephalitis, methylprednisolone was administered. Subsequently, when the patient developed fever, a follow-up neuroimaging study was performed and revealed abnormalities consistent with HSE. The patient was promptly treated with acyclovir, which led to a full recovery. Diagnosing HSE in patients who present without fever or CSF pleocytosis and with typical neuroimaging findings poses a challenge. Therefore, prior to initiating immunosuppressive treatment, it is crucial to closely observe patients and to conduct follow-up tests, including neuroimaging and CSF analysis.

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“…The presence of specific CSF and serum autoantibodies is extremely important for the final diagnosis of AE. CSF antibody detection is more sensitive and specific, so it is better than serum antibody detection ( 72 ).…”

Section: Autoimmune Encephalitis Associated Antibodymentioning

confidence: 99%

Biomarkers in autoimmune diseases of the central nervous system

et al. 2023

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The autoimmune diseases of the central nervous system (CNS) represent individual heterogeneity with different disease entities. Although clinical and imaging features make it possible to characterize larger patient cohorts, they may not provide sufficient evidence to detect disease activity and response to disease modifying drugs. Biomarkers are becoming a powerful tool due to their objectivity and easy access. Biomarkers may indicate various aspects of biological processes in healthy and/or pathological states, or as a response to drug therapy. According to the clinical features described, biomarkers are usually classified into predictive, diagnostic, monitoring and safety biomarkers. Some nerve injury markers, humoral markers, cytokines and immune cells in serum or cerebrospinal fluid have potential roles in disease severity and prognosis in autoimmune diseases occurring in the CNS, which provides a promising approach for clinicians to early intervention and prevention of future disability. Therefore, this review mainly summarizes the potential biomarkers indicated in autoimmune disorders of the CNS.

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Autoimmune‐mediated encephalitis and mimics: A neuroimaging review

Cited by 9 publications

References 113 publications

MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Biomarkers in autoimmune diseases of the central nervous system

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Autoimmune‐mediated encephalitis and mimics: A neuroimaging review

Cited by 9 publications

References 113 publications

MELAS with mtDNA 3243A&gt;G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

MELAS with mtDNA 3243A&gt;G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Biomarkers in autoimmune diseases of the central nervous system

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Product

Resources

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MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review

MELAS with mtDNA 3243A>G mutation presenting as bilateral symmetric occipital and temporal cortices lesions: a case report and literature review