Autoimmune encephalitis, a diagnostic and therapeutic challenge in the intensive care unit

Abstract

Autoimmune encephalitis is a progressive inflammation of the brain, from acute to subacute, associated with antibodies against neuronal cell surface and synaptic protein, most commonly encephalitis against the N-methyl-D-aspartate (NMDA) receptor. New significant findings on etiology show that autoimmune encephalitis is triggered by several etiologies, for example neoplastic processes (breast, lung, kidney, thyroid cancer, ovarian teratoma, and B-cell lymphoma) but also by infections of the nervous system, such as herpes encephalitis. Antibodies against neuronal surface structures are usually direct pathogens and develop their effect through internalization of target proteins, through receptor blockade or complement activation. The type and titer of the antibody e.g. against NMDA receptors, Gamma Amino Butyric (GABA), α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors or voltage-gated potassium channel complexes. An associated tumor, biomarkers, imaging studies, and cerebrospinal fluid are decisive for the prognosis. We present the clinical case of a male patient in the fourth decade of life who is diagnosed with autoimmune encephalitis, we will address the diagnosis and treatment.