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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(01): 2-5
DOI: 10.1590/0004-282X20170179
ARTICLE

Non-inflammatory cerebrospinal fluid delays the diagnosis and start of immunotherapy in anti-NMDAR encephalitis

La ausencia de hallazgos de inflamación en líquido cefalorraquídeo retrasa el inicio de inmunoterapia en la encefalitis anti-NMDAR
Mariana Espinola-Nadurille
1   Instituto Nacional de Neurología y Neurocirugía, Unidad de Neuropsiquiatría, Ciudad de México, México
2   Universidad Nacional Autónoma de México, Facultad de Medicina, División de Posgrado, Ciudad de México, México
,
Paola Bautista-Gomez
1   Instituto Nacional de Neurología y Neurocirugía, Unidad de Neuropsiquiatría, Ciudad de México, México
,
Jose Flores
3   Instituto Nacional de Neurología y Neurocirugía, Subdirección de Neurología, Ciudad de México, México
,
Veronica Rivas-Alonso
3   Instituto Nacional de Neurología y Neurocirugía, Subdirección de Neurología, Ciudad de México, México
,
Rodrigo Perez-Esparza
4   Instituto Nacional de Neurología y Neuricrugía, Laboratorio de Investigación en Adicciones, Ciudad de México, México
,
Rodolfo Solís-Vivanco
5   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neuropsicología, Ciudad de México, México
6   Universidad Nacional Autónoma de México, Facultad de Psicología, Ciudad de México, México.
,
Steven Vargas-Cañas
3   Instituto Nacional de Neurología y Neurocirugía, Subdirección de Neurología, Ciudad de México, México
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ABSTRACT

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalopathy that presents with a wide variety of symptoms, including neuropsychiatric manifestations. The authors’ aim for this study was to analyze the results of paraclinical studies of patients with a diagnosis of anti-NMDAR encephalitis and the association between symptom onset and diagnosis, and start of immunotherapy. Retrospective data of 29 patients with anti-NMDAR encephalitis were gathered and analyzed. Abnormal EEG was found in 27 patients (93.1%), whereas MRI was abnormal in 19 patients (65.5%). In contrast, an inflammatory pattern on CSF analysis was found in only 13 patients (44.8%). The absence of pleocytosis or increased proteins in the CSF was associated with a longer time from symptom onset to diagnosis and treatment (p = 0.003). The authors conclude that noninflammatory CSF may delay the correct diagnosis and start of immunotherapy in anti-NMDAR encephalitis. In the presence of suggestive clinical features, extensive studies including EEG are recommended.

RESUMEN

La encefalitis por receptor anti-N-metil-D-aspartato (anti-NMDAR) es una encefalopatía autoinmune con una amplia variedad de síntomas, incluyendo manifestaciones neuropsiquiátricas. Nuestro objetivo en este estudio fue analizar los resultados paraclínicos de pacientes diagnosticados con encefalitis anti-NMDAR y la asociación entre inicio de sintomatología, el diagnóstico y el inicio de inmunoterapia. Encontramos un EEG anormal en 27 pacientes (93.1%), así como IRM anormal en 19 de ellos (65.5%). En contraste, el análisis de LCR mostró un patrón inflamatorio en tan solo 13 pacientes (44.8%). La ausencia de pleocitosis o proteínas incrementadas en el LCR se asoció con un mayor tiempo desde el inicio de la sintomatología hasta el inicio del tratamiento (p=0.003). Concluimos que el LCR no inflamatorio puede retrasar el diagnóstico correcto y el inicio de tratamiento en encefalitis anti-NMDAR, por lo que se recomienda la realización de estudios exhaustivos, incluyendo EEG, ante la presencia de indicadores clínicos sugerentes del padecimiento.

anti-n-methyl-d-aspartate receptor encephalitis - cerebrospinal fluid - diagnosis
encefalitis antirreceptor n-metil-d-aspartato - líquido cefalorraquídeo - diagnóstico


Publication History

Received: 03 August 2017

Accepted: 29 September 2017

Article published online:
30 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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