| BackgroundAutoimmune encephalitis(AE)is a group of autoimmune central nervous system inflammatory diseases related to specific autoantibodies.Different antigens and antibodies can lead to different AE subtypes,and the combination of different antigens and antibodies can lead to different clinical symptoms and imaging manifestations.The main clinical symptoms of autoimmune encephalitis are seizure,cognitive dysfunction,mental behavior disorder and movement disorder.Autoimmune encephalitis normally fight infection treatment is invalid,and static note to glucocorticoids immunoglobulin and immunosuppressive therapy treatment is good,and the prognosis of autoimmune encephalitis,associated with early identification,diagnosis and treatment of this study on the AE of clinical manifestations,cerebrospinal fluid and magnetic resonance imaging features were analyzed,and provide guidance for clinical early identification of AE.ObjectivesTo explore the general information,clinical manifestations,cerebrospinal fluid and magnetic resonance imaging characteristics of patients with AE,and analyze and summarize the short-term prognosis of known antigen-antibody encephalitis and currently unclassified antigen-antibody encephalitis to provide reference for the diagnosis and treatment of AE.MethodsA total of 63 patients with autoimmune encephalitis admitted to the Second Affiliated Hospital of Guangzhou Medical University from July 2015 to January 2021 were analyzed.1 case was anti-α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic receptor antigen antibody positive encephalitis,and 3 cases were anti-contact protein-associated protein 2 antigen antibody positive encephalitis.2 cases were anti-delta/Notch epidermal growth factor associated receptor antigen antibody encephalitis,1 cases were anti-γ-aminobutyric acid receptor encephalitis,2 cases were anti-glutamate decarboxylase encephalitis,6 cases were anti-glial fibrillary acid protein encephalitis,1 case was anti-neuronucleoprotein encephalitis,and 3 cases were anti-leucine-rich glioma-inactivated protein 1 encephalitis.14 cases were anti-N-methyl-D-aspartic acid receptor encephalitis,2 cases were anti-glutamate receptor 3 encephalitis,and 28 cases were autoimmune encephalitis with neuronal antibody positive which could not be classified by unknown antigen.The general data,clinical manifestations,cerebrospinal fluid and magnetic resonance imaging of 63 patients with AE were analyzed and summarized.Results1.General information: Among the 63 patients with autoimmune encephalitis,43(43/63,68.25%)were male patients and 20(20/63,31.75%)were female patients.The ratio of male to female patients was about 2: 1.The onset age ranged from 14 to 78 years old,with an average age of(38.8±19.0).Among them,1 case was anti-AMPAR encephalitis,3 cases were anti-CASPR2 encephalitis,2 cases were anti-DNER encephalitis,1 case was Gabar encephalitis,2 cases were anti-GAD encephalitis,6cases were anti-GFAP encephalitis,and 1 case was anti-HU encephalitis.3 cases were anti-LGI1 encephalitis,14 cases were anti-NMDAR encephalitis,2 cases were anti-Glu-R3 encephalitis,and 28 cases were autoimmune encephalitis with positive neuron antibody which could not be classified by antigen at present.2.Clinical symptoms: one third of autoimmune encephalitis patients have a prodromal infection before onset,and about half of encephalitis patients present with epileptic seizures.28.6% of patients with autoimmune encephalitis relapsed after treatment,and 14.3%of patients with autoimmune encephalitis complicated with tumor.3.CSF: CSF in patients with autoimmune encephalitis may be manifested as an increase in CSF white blood cell count and CSF protein content.4.Magnetic resonance imaging features: T2 FLAIR showed high signal,mainly in the temporal lobe and hippocampus,and some patients with encephalitis showed no lesions in cranial magnetic resonance imaging.5.The main treatment regimens for autoimmune encephalitis are glucocorticoids,intravenous injection of human immunoglobulin,plasma exchange,immunoadsorption,and immunosuppression.6.There was no statistical difference in short-term prognosis between known and unknown antigen-antibody encephalitis.7.Men had better short-term outcomes,and patients with lesions on cranial MRI had worse short-term outcomes.Conclusion(1)This study suggested that autoimmune encephalitis was more common in young males,with an average age of(38.8±19.0).(2)One-third of autoimmune encephalitis patients have prodromal symptoms before onset,and about half of encephalitis patients have epileptic seizures.(3)28.6% of patients with autoimmune encephalitis relapsed after treatment,and14.3% of patients with autoimmune encephalitis complicated with tumor.(4)The CSF of patients with autoimmune encephalitis can be manifested as the increase of CSF white blood cell count and CSF protein content,and some patients with encephalitis can be manifested as the absence of lesions in cranial magnetic resonance.(5)There was no statistical difference in short-term prognosis between known and unknown antigen-antibody encephalitis.(6)Male patients had a better short-term prognosis,and cranial MRI showed a worse short-term prognosis in patients with lesions... |
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