Imaging of autoimmune encephalitis – Relevance for clinical practice and hippocampal function

Heine, J.; Prüß, Harald; Bartsch, Thorsten; Ploner, Christoph J.; Paul, Friedemann; Finke, Carsten

doi:10.1016/j.neuroscience.2015.05.037

Cited by 239 publications

(246 citation statements)

References 112 publications

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“…We did not find extratemporal lesions, i.e. basal ganglia hyperintensities in our patients including FBDS cases in contrast to earlier studies [9,10,14,30,31]. Nevertheless, we found that higher volume of the putamen was associated with better cognition measured by ACE test at 23.4±7.6 months indicating the affection of the basal ganglia also in our studies, and that basal ganglia atrophy may affect functional outcomes in patients with LGI1 encephalitis.…”

Section: Discussioncontrasting

confidence: 99%

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Szőts

Blaabjerg

Orsi

et al. 2017

Journal of the Neurological Sciences

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Background: Chronic cognitive deficits are frequent in leucin-rich glioma-inactivated 1 protein (LGI1) encephalitis. We examined structural and metabolic brain abnormalities following LGI1 encephalitis and correlated findings with acute and follow-up clinical outcomes. Methods:Nine patients underwent prospective multimodal 3 Tesla MRI 33.1±18 months after disease onset, including automated volumetry, diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS). Data were compared to 9 age-and sex-matched healthy controls. Conclusions:Poor clinical outcome following LGI1 encephalitis is associated with global brain atrophy and disintegration of white matter tracts. The pathological changes affect not only temporomesial structures but also frontal lobes and the cerebellum.

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Section: Discussioncontrasting

confidence: 99%

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Szőts

Blaabjerg

Orsi

et al. 2017

Journal of the Neurological Sciences

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“…The related investigation of autoantibodies in in neuronal cell membranes and synapses has not only changed the pattern of encephalitis study, but also expanded the study scope to cover the mental illness, epilepsy, dyskinesia and cognitive dysfunction (1). Previous studies have demonstrated that there are more cases of anti-NMDAR encephalitis than other kinds of autoimmune encephalitis (11,19). In 2010, the first case report of anti-NMDAR encephalitis was published in China (4), and many cases of adult and pediatric patients have been reported since (5).…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnosis and treatment of pediatric anti‑N‑methyl‑D‑aspartate receptor encephalitis: A single center retrospective study

et al. 2018

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Abstract. The aim of the present retrospective study was to investigate the diagnosis, treatment and prognosis of pediatric anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. A total of 23 pediatric patients with anti-NMDAR encephalitis were included in the present study. The clinical data, laboratory test results, imaging examination, treatment outcomes, and follow-up records were reviewed and analyzed. A total of 8 patients exhibited prodromal symptoms, including fever, cough, and vomiting. Clinical symptoms included epilepsy, convulsions, ataxia, coma, dyskinesia, personal behavior change and hallucinations. A total of 20 cases had the initial neurologic symptoms of dyskinesia or seizure, whereas 3 cases exhibited psychiatric symptoms of personal behavior change and hallucinations. Furthermore, pediatric patients >6 years old had more psychiatric symptoms than those ≤6 years. A total of 20 cases exhibited abnormal electroencephalography records, with 1 case of extreme δ brush. A total of 10 cases exhibited abnormal brain magnetic resonance imaging detection. Furthermore, the CSF protein contents for pediatric patients ≤6 years old was significantly higher than those >6 years. For treatment, 18 pediatric patients received the first-line treatment of methylprednisone and intravenous injection of immunoglobulin, and 6 cases were subjected to the second-line treatment of rituximab. A total of 2 patients underwent plasma exchange and/or cyclophosphamide treatment. In follow-up, 12 cases reported no convulsion, whereas 11 cases had moderate or severe neurological and psychiatric sequelae. The recovery rate for pediatric patients ≤6 years old was significantly higher than those >6 years. Anti-NMDAR encephalitis is commonly seen in pediatric patients, mainly with initial neurological symptoms. These patients could respond to immunotherapy, and younger pediatric patients typically have a better prognosis.

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“…MRI abnormalities are present in 23%-50% of cases and typically show non-specific enhancement in the cortex or subcortical structures, although diffusion tensor imaging (DTI) may reveal widespread white matter damage. [4] EEG shows non-specific generalized slowing in up to 90% of cases. [3] Brain biopsy has been done in some patients, but typically shows normal tissue or nonspecific changes, therefore is generally not indicated.…”

Section: Discussionmentioning

confidence: 99%

Acute psychosis as a harbinger of a tumor: A case of anti-N-methyl-D-aspartate receptor encephalitis

Gleason

Donato

Poudel

2017

CRIM

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An obese but otherwise healthy 22-year-old female presented to the hospital with an episode of acute psychosis. On exam the patient was febrile and had labile systolic blood pressure. Urine drug screen and infectious workup were negative. A CSF Anti-N-methyl-D-aspartate (Anti-NMDA) receptor antibody was positive. Brain magnetic resonance imaging (MRI) showed hyperintensity in the left hippocampus on diffusion weighted imaging (DWI). The patient was started on prednisone, intravenous immunoglobulins, and rituximab. Hospital course was complicated by seizures and autonomic instability, requiring prolonged stay in the ICU. Cognitive, motor, and autonomic function gradually improved with therapy. Magnetic resonance imaging of the pelvis revealed a 3 cm × 3 cm left ovarian teratoma that was removed with oophorectomy. The patient was discharged to rehab hospital for continued treatment and physical therapy.

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Imaging of autoimmune encephalitis – Relevance for clinical practice and hippocampal function

Cited by 239 publications

References 112 publications

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Clinical diagnosis and treatment of pediatric anti‑N‑methyl‑D‑aspartate receptor encephalitis: A single center retrospective study

Acute psychosis as a harbinger of a tumor: A case of anti-N-methyl-D-aspartate receptor encephalitis

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