{"title":"Clinical and Brain MRI Characteristics of Patients with Anti-N-Methyl-<sc>d</sc>-Aspartate Receptor Encephalitis: A 10-Year Retrospective Study.","authors":"Yuliang Wang, Qin Zhou, Zhaojun Dai, Yingwei Qiu, Hongyan Zhou, Li Feng, Jing Zhao","doi":"10.1159/000546521","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate the diagnostic utility of brain Magnetic resonance imaging (MRI) in anti-N-methyl-<sc>d</sc>-aspartate receptor encephalitis (anti-NMDAR encephalitis) and analyze the relationship between clinical and brain MRI characteristics and disease prognosis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on forty-six (59% female, median age: 24.5 years) clinically identified anti-NMDAR encephalitis patients from December 2012 to April 2022. All the patients underwent multiparametric MRI, with thirteen returning for follow-up. All the relevant clinical information was collected. The initial and follow-up brain MRI was sequentially analyzed for signal abnormalities, involvement of anatomy and structure, and brain/structure atrophy by two experienced neuroradiologists. Additionally, the relationship between clinical and brain MRI features and prognosis was examined.</p><p><strong>Results: </strong>The most common symptom (33/46, 72%) in anti-NMDAR encephalitis was aberrant psychiatric behavior. Five (10%) cases combined with other positive antibodies. Although 91% of patients with mRS >2 before treatment, a statistically significant decrease mRS were observed after treatment (mRS: 3.50 ± 0.94 vs. mRS: 1.91 ± 1.53, p < 0.001). More than half of the patients had abnormal MRI findings. T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintense lesions that involve the frontal lobe and the limbic system are the characteristic imaging predilection of anti-NMDAR encephalitis. On follow-up MRI, we noticed 5 patients with significant hippocampal atrophy. Further analysis showed that the hippocampal involvement was a significant factor in predicting worse mRS scores both before and after treatment (p < 0.05).</p><p><strong>Conclusion: </strong>T2-FLAIR hyperintense lesions in the frontal lobe and the limbic system are indicative of anti-NMDAR encephalitis. The involvement of the hippocampus is a risk factor for a poor prognosis.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-11"},"PeriodicalIF":2.1000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000546521","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: The aim of this study was to investigate the diagnostic utility of brain Magnetic resonance imaging (MRI) in anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDAR encephalitis) and analyze the relationship between clinical and brain MRI characteristics and disease prognosis.
Methods: A retrospective analysis was conducted on forty-six (59% female, median age: 24.5 years) clinically identified anti-NMDAR encephalitis patients from December 2012 to April 2022. All the patients underwent multiparametric MRI, with thirteen returning for follow-up. All the relevant clinical information was collected. The initial and follow-up brain MRI was sequentially analyzed for signal abnormalities, involvement of anatomy and structure, and brain/structure atrophy by two experienced neuroradiologists. Additionally, the relationship between clinical and brain MRI features and prognosis was examined.
Results: The most common symptom (33/46, 72%) in anti-NMDAR encephalitis was aberrant psychiatric behavior. Five (10%) cases combined with other positive antibodies. Although 91% of patients with mRS >2 before treatment, a statistically significant decrease mRS were observed after treatment (mRS: 3.50 ± 0.94 vs. mRS: 1.91 ± 1.53, p < 0.001). More than half of the patients had abnormal MRI findings. T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintense lesions that involve the frontal lobe and the limbic system are the characteristic imaging predilection of anti-NMDAR encephalitis. On follow-up MRI, we noticed 5 patients with significant hippocampal atrophy. Further analysis showed that the hippocampal involvement was a significant factor in predicting worse mRS scores both before and after treatment (p < 0.05).
Conclusion: T2-FLAIR hyperintense lesions in the frontal lobe and the limbic system are indicative of anti-NMDAR encephalitis. The involvement of the hippocampus is a risk factor for a poor prognosis.
期刊介绍：
''European Neurology'' publishes original papers, reviews and letters to the editor. Papers presented in this journal cover clinical aspects of diseases of the nervous system and muscles, as well as their neuropathological, biochemical, and electrophysiological basis. New diagnostic probes, pharmacological and surgical treatments are evaluated from clinical evidence and basic investigative studies. The journal also features original works and reviews on the history of neurology.
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