Limbic encephalitis: a clinical‐radiological comparison between herpetic and autoimmune etiologies

Oyanguren, B.; Sánchez, Víctor Aguilar; González, Francisco José Galván; Felipe, A. de; Esteban, L. Izquierdo; López-Sendón, J.L.; García‐Barragán, Nuria; Millán, Juan Salvador Martínez San; Masjuán, Jaime; Corral, Íñigo

doi:10.1111/ene.12249

Cited by 79 publications

(67 citation statements)

References 10 publications

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“…As well, involvement of the basal ganglia, thalamus, and (orbital) frontal lobe may appear; our series changes were even bilateral in 53 % of patients (Chow et al 2015;Domingues et al 1998;Oyanguren et al 2013;Sili et al 2014). Our study suggests the superiority of DWI to conventional T2-or FLAIR-weighted MRI in detection of early signal abnormalities in HSVE (Renard et al 2015).…”

Section: Mri Imagingsupporting

confidence: 52%

“…This may be of particular importance especially in cases with initial normal CSF and missing systemic inflammatory signs. Nevertheless, MRI may even be repeatedly negative in PCR-based HSVE (Hollinger et al 2000;Sheybani et al 2013) even when DWI imaging was performed (Oyanguren et al 2013). In our study, 2/15 HSV patients remained negative in MRI imaging including DWI in one patient (done on second day after onset of symptoms).…”

Section: Mri Imagingmentioning

confidence: 44%

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A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

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The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.

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Section: Mri Imagingsupporting

confidence: 52%

Section: Mri Imagingmentioning

confidence: 44%

A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

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“…10 In addition, even though both HSE and LE involve the TL, basal ganglia involvement on MR imaging favors nonherpetic etiologies. 12 It has been demonstrated that some types of viral encephalitis can trigger autoimmune LE, 53,54 particularly anti-Nmethyl-D-aspartate receptor encephalitis. 55 This phenomenon occurs when prolonged or atypical neurologic symptoms recur after successful control of the viral infection.…”

Section: Infectious Lementioning

confidence: 99%

“…In addition, symptoms can precede the diagnosis of cancer, and T2/FLAIR hyperintensity in the medial aspect of the TL may mimic several other disorders. [4][5][6][7][8][9][10][11][12] MR imaging plays a key role in the management of patients with suspected LE and is used as part of the LE diagnostic criteria to rule out differential diagnoses. Certain imaging and clinical peculiarities may narrow the list of possible diagnoses; however, a complete list of differential diagnoses remains beyond the scope of this article.…”

mentioning

confidence: 99%

Recognizing Autoimmune-Mediated Encephalitis in the Differential Diagnosis of Limbic Disorders

Rocha

Nunes

Maia

et al. 2015

AJNR Am J Neuroradiol

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SUMMARY: Limbic encephalitis is far more common than previously thought. It is not always associated with cancer, and it is potentially treatable. Autoantibodies against various neuronal cell antigens may arise independently or in association with cancer and cause autoimmune damage to the limbic system. Neuroimaging plays a key role in the management of patients with suspected limbic encephalitis by supporting diagnosis and excluding differential possibilities. This article describes the main types of autoimmune limbic encephalitis and its mimic disorders, and emphasizes their major imaging features.ABBREVIATIONS: AME ϭ autoimmune-mediated encephalopathy; AMPAR ϭ ␣-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; CASPR2, contactin-asso-

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“…While limbic dysfunction is the single most consistent finding in autoimmune encephalitis, varying degrees of involvement are seen within the neocortex, striatum, hindbrain, spine, and peripheral nervous system based on the unique antibody profile. 3,[9][10][11][12] In addition, certain antibody subtypes consistently lack imaging manifestations, while others characteristically demonstrate prominent "extralimbic" involvement. 3,7,[13][14][15] Although it was initially thought to be relatively rare, there is growing consensus that autoimmune encephalitis is responsible for a subset of altered mental status previously considered idiopathic.…”

mentioning

confidence: 99%

Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis

Kelley¹,

Patel²,

Marin³

et al. 2017

AJNR Am J Neuroradiol

249

192

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SUMMARY: Autoimmune encephalitis is a relatively new category of immune-mediated disease involving the central nervous system that demonstrates a widely variable spectrum of clinical presentations, ranging from the relatively mild or insidious onset of cognitive impairment to more complex forms of encephalopathy with refractory seizure. Due to its diverse clinical features, which can mimic a variety of other pathologic processes, autoimmune encephalitis presents a diagnostic challenge to clinicians. Imaging findings in patients with these disorders can also be quite variable, but recognizing characteristic findings within limbic structures suggestive of autoimmune encephalitis can be a key step in alerting clinicians to the potential diagnosis and ensuring a prompt and appropriate clinical work-up. In this article, we review antibody-mediated encephalitis and its various subtypes with a specific emphasis on the role of neuroimaging in the diagnostic work-up. ABBREVIATIONS:

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Limbic encephalitis: a clinical‐radiological comparison between herpetic and autoimmune etiologies

Abstract: There are few differences between HE and AE. Psychiatric symptoms and association with tumors were unique for AE. Acute onset with fever and absence of basal ganglia involvement in magnetic resonance imaging support a diagnosis of HE.

Cited by 79 publications

References 10 publications

A study on viral CNS inflammation beyond herpes encephalitis

A study on viral CNS inflammation beyond herpes encephalitis

Recognizing Autoimmune-Mediated Encephalitis in the Differential Diagnosis of Limbic Disorders

Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis

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