Abnormal Brain MRI Findings in Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Correlation With Outcomes.

Chunyan Lei,Lianmei Zhong,Xiaolong Chang,Haijiang Li

doi:10.3389/fneur.2022.834929

Abstract

PurposeThe reported prevalence of abnormal findings by brain MRI varies from 11 to 83% among patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Here, we investigated the prevalence of abnormal MRI findings in Chinese patients and explored whether such findings are correlated with clinical outcomes.MethodsThis retrospective study analyzed a consecutive series of 52 patients with anti-NMDAR encephalitis admitted to our hospital. The patients were assigned to the “MRI-normal” or the “MRI-abnormal” group based on brain MRI after admission. The groups were compared in terms of clinicodemographic characteristics and scores on the Mini-Mental State Examination (MMSE) and modified Rankin Scale (mRS) 3 and 12 months after admission.ResultsThirty-seven (71.15%) of the patients showed abnormalities on brain MRI; these patients were more likely to be men and showed abnormalities on electroencephalography. Patients who showed normal or abnormal MRI findings did not differ significantly in terms of clinical symptoms, rates of mortality or relapse, or mRS scores after 3 and 12 months. However, patients with abnormal MRI showed significantly lower MMSE scores than those with normal MRI after 3 and 12 months.ConclusionsWe found high prevalence of abnormal MRI findings in our sample of Chinese patients with anti-NMDAR encephalitis. We also found that the abnormal findings were associated with cognitive decline but not necessarily with mortality or functional outcomes in the short or long term.

Highlights

In anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, autoimmune antibodies bind and inactivate the NMDAR, which plays pivotal roles in synaptic transmission and plasticity [1, 2]
Anti-NMDAR encephalitis can manifest as various syndromes, including seizures, autonomic instability, neuropsychiatric symptoms, memory disorder, dyskinesia, movement disorder, disturbed consciousness, and speech disorders
57 patients with anti-NMDAR encephalitis were admitted to our hospital, but five were lost to follow-up, so the final analysis included 52 patients (Table 1)

Summary

Introduction

In anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, autoimmune antibodies bind and inactivate the NMDAR, which plays pivotal roles in synaptic transmission and plasticity [1, 2]. Anti-NMDAR encephalitis can manifest as various syndromes, including seizures, autonomic instability, neuropsychiatric symptoms, memory disorder, dyskinesia, movement disorder, disturbed consciousness, and speech disorders. Anti-NMDAR encephalitis can be cured, immunotherapy has not been standardized [1–4]. The disease is typically diagnosed based on detection of anti-NMDAR antibodies in cerebrospinal fluid and/or serum, together with clinical characteristic, laboratory findings, brain

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Conclusion