Clinical Analysis Of 12 Cases Of Autoimmune Encephalitis And Literature Review

Objective:In this paper,general clinical data,clinical manifestations,laboratory examinations,electroencephalogram,skull MRI,cerebrospinal fluid examination,tumor screening,treatment plan and efficacy,and follow-up results of 12 patients with autoimmune encephalitis(Autoimmune encephalitis,AE)were collected for comprehensive analysis.Combined with relevant literatures at home and abroad,the pathogenesis,clinical manifestations,laboratory examination,imaging examination,treatment,efficacy and follow-up results of patients with various types of autoimmune encephalitis were discussed to provide references for clinical diagnosis and treatment.Methods:Twelve patients who were hospitalized in the department of neurology of the first affiliated hospital of bengbu medical college from September 2016 to February 2019 and were finally diagnosed as AE were collected.General data,clinical manifestations,immune indicators,tumor screening,cerebrospinal fluid examination.eeg,head MRI.treatment and efficacy,and follow-up results were collected.Finally.the data of 12 patients with autoimmune encephalitis were retrospectively analyzed.At the same time,charts were used to describe the specific situation of each patient,and the characteristics of each type of AE were analyzed.Results:A total of 12 patients who met the diagnostic criteria for autoimmune encephalitis and were positive for cerebrospinal fluid and/or serum antibodies were enrolled,including 8 patients with anti-NMDA receptor encephalitis and 4 patients with anti-GABA(B)receptor encephalitis.1.Among the 8 patients with anti-NMDAR encephalitis,6 were male and 2 were female,ranging in age from 25 to 71 years old,including 4 young patients(<30 years oId).4 patients presented with prodrome infection before onset.1 case with fever headache as the first symptom;1 case with consciousness disorder as the first symptom;3 cases with epilepsy as the first symptom;the other 3 cases with mental and behavioral abnormalities as the first symptom.There were symptoms of autonomic nervous disorder in the course of 5 patients.Electroencephalogram was abnormal in 4 patients.mainly presenting as slow wave increase,Head MRI was abnormal in 5 patients,with abnormal high signal in temporal lobe,insula,hippocampus and lateral fissure.CSF mainly showed increased white blood cells and protein.Seven patients were treated with immunotherapy,and all of them achieved different degrees of remission,among which 3 patients were still left with varying degrees of cognitive impairment at discharge.2.Among the 4 patients with anti-GABA(B)receptor encephalitis,2 were male and 2 were female,with an age range of 49-71 years,and 3 of them had symptoms of prodromal infection.One patie'nt had memory loss as the first clinical manifestation,and 3 patients had epilepsy as the first clinical manifestation.Clinical manifestations of mental behavioral abnormalities and epilepsy were common,and all four patients developed seizures and mental problems(such as hallucinations or behaviors,mood and personality changes).Two patients showed abnormal eeg,one showed diffuse slow wave and one showed epileptiform discharge.Head MRI examination was performed in 4 patients,and abnormal signals were found in 3 patients,mainly distributed in temporal lobe,insula,hippocampus and lateral ventricle.One case was found with hilum occupying and died after discharge due to poor recovery considering the possibility of lung cancer.1 case was completely recovered from discharge.The remaining 2 cases were in remission.Conclusion:Autoimmune encephalitis mostly occurs in acute or subacute onset.The main clinical manifestations are abnormal mental behavior,seizures,cognitive decline,disturbance of consciousness,and autonomic dysfunction.Nearly half of the patients had fever,headache and other prodromal symptoms.Relevant laboratory tests can be used to rule out other diseases and should be routinely screened for tumours,which should be treated if they are present.EEG examination is usually abnormal.Most of the patients presented abnormal head MRI,mainly involving limbic system.The change of CSF was mainly caused by the increase of white blood cells and the normal or slight increase of protein content,but they all lacked specificity.The main treatment of AE is immunotherapy.Early diagnosis and immunotherapy can often improve the efficacy of autoimmune encephalitis and significantly improve the prognosis of patients.