| Objective:1.The clinical features of different subtypes of autoimmune encephalitis(AE)were summarized.2.To explore the commonness and difference of clinical features between autoimmune encephalitis(AE)and viral encephalitis(VE).Methods:From February 2015 to October 2018,36 patients with autoimmune brain disease(including age,sex,previous medical history,onset form,clinical manifestation)were collected from The Second Hospital of Shanxi Medical University Neurology.The clinical features of different subtypes of AE were summarized based on previous literature.The clinical data of 52 patients with VE in the same period were collected and compared by univariate chi-square test and multi-factor Logistic regression analysis.The results showed that there was statistical difference and no difference between the two groups.Generalizing and summarizing the commonness and absence of patients with AE and VE Same point.Results:1.Among the 36 patients with AE,17 were male and 19 female,with an average age of 46.86±17.30 years.There were 15 cases of anti-N-methyl-D-aspartic acid receptor(NMDAR)and 7 cases of anti-leucine-rich glioma inactivation protein 1(LGI1)encephalitis.There were 2 cases of anti-contact protein-related protein 2(Caspr2)antibody encephalitis,6 cases of anti-?-aminobutyric acid receptor(GABAR)antibody encephalitis and 6 cases of anti-Hu-Yo-Ri antibody encephalitis.2.Among the 36 patients with autoimmune encephalitis,8 had first symptoms of abnormal mental behavior(anti-NMDAR positive in 4 cases,anti-LGI1 positive in 2cases,anti-GABAR positive in 1 case,anti-Hu-Yo-Ri1 in 1 case);The first symptom was epilepsy in 10 cases(anti-NMDAR positive in 3 cases,anti-LGI1 positive in 3 cases,anti-GABAR positive in 3 cases,anti-Hu-Yo-Ri1 in 3 cases);The symptoms of headache and fever occurred in 10 cases(anti-NMDAR positive in 7 cases,anti-LGI1 positive in 1case,anti-GABAR positive in 1 case and anti-Hu-Yo-Ri1 in 1 case);There were 3 cases with hypofunction(anti-NMDAR positive in 1 case,anti-GABAR positive in 1 case,anti-Hu-Yo-Ri1 in 1 case);Limb paralysis was found in 4 cases(anti-Hu-Yo-Ri in 2cases,anti-Caspr2 in 2 cases)and involuntary movement in 2 cases(anti-LGI1 in 2cases).3.Among 36 patients with autoimmune encephalitis,20 had subacute onset,7 with tumor(2 with anti-NMDAR with teratoma,1 with rectal cancer,2 with anti-GABAR with lung cancer,1 with anti-Hu-Yo-Ri with lung cancer and 1 after breast cancer resection);There were 20 cases with mental symptoms(anti-NMDAR in 12 cases,anti-LGI1 in 3 cases,anti-GABAR in 3 cases,anti-Hu-Yo-Ri in 2 cases);epilepsy in 19cases(anti-NMDAR in 9 cases,anti-LGI1 in 3 cases,anti-GABAR in 4 cases,anti-Hu-Yo-in 4 cases);There were 16 cases of cognitive dysfunction(5 cases of anti-NMDAR,5 cases of anti-LGI1,3 cases of anti-GABAR,2 cases of anti-Hu-Yo-Ri,1case of anti-Caspr2);11 cases of involuntary movement(6 cases of anti-NMDAR,3cases of anti-LGI1,1 case of anti-GABAR,1 case of anti-Hu-Yo-Ri),7 cases of limb weakness/ataxia(1 case of anti-NMDAR,1 case of anti-GABAR,3 cases of anti-Hu-Yo-Ri,2 cases of anti-Caspr2)and 11 cases of autonomic dysfunction(5 cases of anti-NMDAR,Anti-LGI1 in 3 cases,anti-Hu-Yo-Ri in 1 case,anti-Caspr2 in 2 cases);consciousness disorder in 12 cases(anti-NMDAR in 7 cases,anti-LGI1 in 3 cases,anti-GABAR in 1 case,anti-Hu-Yo-Ri in 1 case);central hypopnea in 4 cases(anti-NMDAR in 3 cases,anti-LGI1 in 1 case);There were 8 patients with speech disorder(anti-NMDAR in 4 cases,anti-LGI1 in 1 case,anti-GABAR in 1 case,anti-Hu-Yo-Ri in 2 cases)and sensory abnormalities(anti-NMDAR in 1 case,anti-Hu-Yo-Ri in 1 case,2 cases of anti-Caspr2).4.Among 36 patients with AE,12 had elevated(WBC)(6 anti-NMDAR,2anti-LGI1,2 anti-GABAR,2 anti-Hu-Yo-Ri),14 had elevated C-reactive protein(CRP)(anti-NMDAR in 7,anti-LGI1 in 3,and anti-GABAR in 1).Anti-Hu-Yo-Ri in 3 cases,sodium(Na)in 5 cases(anti-NMDAR in 1 case,anti-LGI1 in 3 cases,anti-Hu-Yo-Ri in 1case),multiple tumor markers(C12)elevated in 8 cases(anti-NMDAR in 4 cases,anti-Hu-Yo-Ri in 2 case and anti-GABAR in 2 cases);There were 11 cases with elevated cerebrospinal fluid(CSF)pressure(anti-NMDAR in 5 cases,anti-LGI1 in 2 cases,anti-GABAR in 1 case,anti-Hu-Yo-Ri in 2 cases,anti-Caspr2 in 1 case),leukocyte elevation in 20 cases(anti-NMDAR in 11 cases,anti-LGI1 in 2 cases,anti-GABAR in 3cases,anti-Hu-Yo-Ri in 4 cases);15 cases of lymphocyte elevation(9 cases of anti-NMDAR,1 case of anti-LGI1,2 cases of anti-GABAR,3 cases of anti-Hu-Yo-Ri),egg White elevation was found in 11 cases(anti-NMDAR in 5 cases,anti-LGI1 in 2cases,anti-GABAR in 2 cases and anti-Hu-Yo-Ri in 2 cases);Cephalic magnetic field(MRI)single/bilateral frontal temporal occipital lobe,hippocampus,island lobe,basal ganglia edema or local abnormal signal in 14 cases(anti-NMDAR 6 cases,anti-LGI1 3cases,anti-GABAR 2 cases,anti-Hu-Yo-Ri 2 cases,anti-Caspr2 1 case).5.The results of univariate X~2test showed that the clinical features of AE and VE groups were significantly different(P?0.1),including the onset mode,headache,fever precursor and limb paralysis in the first symptom;seizures,cognitive dysfunction,central hypopnea and involuntary movement in the course of the disease;and the difference between the two groups was statistically significant(P?0.1),including Multiple tumor markers in laboratory tests,increased CSF pressure and protein content;The index of P?0.1 in univariate analysis was included in the multivariate Logistic regression analysis,The clinical characteristics of the difference were statistically significant(P<0.05).The clinical characteristics of the difference were as follows:onset form(OR:3.795,CI1.094-13.166,P<0.05);prodromal symptoms(OR:0.290,CI:0.085-0.991,P<0.05);Seizure(OR:3.617,CI:1.025-12.766,P<0.05)and involuntary movement(OR:10.733,CI:1.956-58.905,P<0.05);CSF protein increased(OR:0.178,CI 0.049-0.653,P<0.05).Conclusion:1.Anti-NMDAR antibody meningitis is the most common in young patients.Mouth-tongue motor disorder and central hypopnea are relatively specific symptoms.Some of them are complicated with teratoma,CSF pressure,inflammation or protein index are mostly mild to moderate.2.Anti-LGI1 antibody meningitis has epileptic seizures,decreased near memory,outstanding mental symptoms,and is prone to onset of(FBDS)and hyponatremia with facial and brachial dystonia,most of the cephalic MRI showed unilateral/bilateral temporal lobe and abnormal signals in hippocampus.3.The main manifestations of anti-GABAR antibody meningitis were epileptic seizures,mental symptoms and cognitive impairment.Most of the seizures were stubborn and severe,some of them were complicated with lung cancer/thymoma,and CSF/skull MRI was not specific.4.Anti-Hu-Yo-Ri antibody meningitis has many manifestations,such as limbic lobe meningitis,brainstem meningitis,encephalomyelitis,optic neuropathy,sensory neuron disease,autonomic neuropathy,myopathy and so on,CSF/skull MRI is not specific.5.Anti-Caspr2 antibody meningitis has limbic system involvement,Parkinson-like symptoms,neuromyotonia and Mowang syndrome;Mowang syndrome is dominated by peripheral nerve involvement such as muscle twitching,muscle weakness,central nervous system damage such as sleep disorder/emotional instability,and autonomic nerve dysfunction,some of which are complicated with thymoma;Abnormal signals were found in the medial temporal lobe,hippocampus and basal ganglia on MRI.6.Compared with the clinical features of AE and VE,AE is mostly subacute onset,VE is mostly acute onset.Compared with VE,AE often lacks headache,fever and other prodromal manifestations,and AE is more prone to seizures and autonomic movement,while the increase of cerebrospinal fluid protein is more likely to occur in VE.There was no significant difference in other neurological defects and blood/cerebrospinal fluid indexes between the two groups. |
PDF Full Text Request