Autoimmune encephalitis: neurologist’s view (complex questions of diagnostics)

Abstract

   Autoimmune encephalitides (AIE) are non-infectious immune-mediated inflammatory diseases of the brain parenchyma with frequent lesions of the cortex or deep gray matter with or without involvement of the white matter, meninges, or spinal cord. The most common clinical syndromes of AIE are disorders of the psyche, behavior, cognitive and autonomic functions, movement disorders, as well as epileptic seizures. The diagnosis of AIE can be complicated by the isolated presentation of psychopathological hallucinatory-delusional and emotional-affective symptoms, which can imitate the onset of an idiopathic mental disorder and requires a certain alertness and increased attention to the anamnesis data and assessment of the neurological status. The MRI pattern of limbic encephalitis with unilateral or bilateral involvement of the medial temporal lobes is typical for AIE, however, both normal MRI of the brain and/or spinal cord and involvement of various brain regions in different subtypes of AIE are possible. It is necessary to consider the possibility of not only a recurrent course of AIE, but also the possibility of the overlapping syndromes of AIE and other autoimmune disorders development, including demyelinating diseases – multiple sclerosis, neuromyelitis optica spectrum disorders or diseases associated with antibodies to myelin oligodendrocyte glycoprotein, which requires longer observation due to the risk of relapse of autoimmune diseases.