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The authors enrolled 53 patients with anti-N-methyl-D-aspartate receptor encephalitis and performed 2-year follow-up. Brain MRIs were acquired for all patients at the onset phase. The brain MR imaging manifestations were classified into 4 types—type 1: normal MR imaging findings; type 2: only hippocampal lesions; type 3: lesions not involving the hippocampus; and type 4: lesions inboth the hippocampus and other brain areas. Twenty-eight (28/53, 53%) patients had normal MR imaging findings (type 1), and the others (25/53, 47%) had abnormal MRI findings—type 2: 7 patients (13%); type 3: 7 patients (13%); and type 4: 11 patients (21%). The presence of hippocampal lesions and relapse was associated with poor outcome.

Abstract

Figure 2 from paper
Lesion probability map of brain MR imaging. The mean lesion probability distribution thresholded at 34% is shown in light blue and thresholded at 1% is shown in blue and overlaid on the ICBM152 T1 template in the Montreal Neurological Institute space.

BACKGROUND AND PURPOSE

Anti-N-methyl-D-aspertate receptor encephalitis is an autoimmune-mediated disease without specific brain MRI features. Our aim was to investigate the brain MR imaging characteristics of anti-N-methyl-D-aspartate receptor encephalitis and their associations with clinical outcome at a 2-year follow-up.

MATERIALS AND METHODS

We enrolled 53 patients with anti-N-methyl-D-aspartate receptor encephalitis and performed 2-year follow-up. Brain MRIs were acquired for all patients at the onset phase. The brain MR imaging manifestations were classified into 4 types: type 1: normal MR imaging findings; type 2: only hippocampal lesions; type 3: lesions not involving the hippocampus; and type 4: lesions in both the hippocampus and other brain areas. The modified Rankin Scale score at 2-year follow-up was assessed, and the association between the mRS and onset brain MR imaging characteristics was evaluated.

RESULTS

Twenty-eight (28/53, 53%) patients had normal MR imaging findings (type 1), and the others (25/53, 47%) had abnormal MRI findings: type 2: 7 patients (13%); type 3: seven patients (13%); and type 4: eleven patients (21%). Normal brain MRI findings were more common in female patients (P = .02). Psychiatric and behavioral abnormalities were more common in adults (P = .015), and autonomic symptoms (P = .025) were more common in pediatric patients. The presence of hippocampal lesions (P = .008, OR = 9.584; 95% CI, 1.803–50.931) and relapse (P = .043, OR = 0.111; 95% CI, 0.013–0.930) was associated with poor outcome.

CONCLUSIONS

Normal brain MRI findings were observed in half of the patients. Lesions in the hippocampus were the most common MR imaging abnormal finding. The presence of hippocampal lesions is the main MR imaging predictor for poor prognosis in patients with anti-N-methyl-D-aspartate receptor encephalitis.

Read this article: http://bit.ly/2wL2agu

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