Materiały źródłowe

• #1 Diagnostics in infectious encephalitis | Encephalitis International

  https://www.encephalitis.info/diagnosis-of-encephalitis/diagnostics-in-infectious-encephalitis/

  Infectious encephalitis is an inflammation of the brain caused by an infection invading the brain. […] Encephalitis is a neurological emergency which needs to be diagnosed as soon as possible to avoid severe after-effects such as disability or death. […] The diagnosis of infectious encephalitis aims to establish that there is inflammation within the brain, and secondly to find the cause of the inflammation. […] Although the identification of the pathogens causing encephalitis remains challenging, and in many cases the cause is still unknown, there have been many advances in the diagnosis of encephalitis over the past few years. […] Not one test/symptom is enough for making a diagnosis of encephalitis, but rather a combination of tests and assessments. […] Based on the information from the above assessments, the doctor will perform various diagnostic tests to confirm the diagnosis and find the cause of encephalitis.

• #2 Diagnosis and management of acute encephalitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4121461/

  Encephalitis results from inflammation of the brain parenchyma, and may be caused by infections or autoimmune conditions. Diagnosis is typically made by a combination of clinical, laboratory, neuroimaging, and electrophysiologic findings. A number of case definitions have been developed, which generally require encephalopathy, as characterized by alteration in consciousness or personality change lasting for a sustained period of time (typically greater than 24 hours). To distinguish encephalitis from other causes of encephalopathy, key features include presence of fever, CSF pleocytosis, or MRI or EEG changes compatible with encephalitis. […] A practical approach to diagnosis in adults is presented. In addition to routine studies to investigate for causes of encephalopathy, all patients with suspected encephalitis should undergo blood cultures and HIV testing.

• #3 Encephalitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/436

  Encephalitis is a pathological state of brain parenchymal inflammation leading to an altered state of consciousness or focal neurological signs. […] Initial investigations should always include blood cultures, neuroimaging (preferably magnetic resonance imaging), and cerebrospinal fluid analysis (unless contraindicated). […] Encephalitis is defined as inflammation of the brain parenchyma associated with neurological dysfunction, such as altered state of consciousness, seizures, personality changes, cranial nerve palsies, speech problems, and motor and sensory deficits. […] Key diagnostic factors include presence of risk factors, fever, rash, altered mental state, focal neurological deficit, meningismus, parotitis, lymphadenopathy, optic neuritis, acute flaccid paralysis, and movement disorder.

• #4 Encephalitis – Wikipedia

  https://en.wikipedia.org/wiki/Encephalitis

  People should only be diagnosed with encephalitis if they have a decreased or altered level of consciousness, lethargy, or personality change for at least twenty-four hours without any other explainable cause. […] Diagnosing encephalitis is done via a variety of tests: […] Brain scan, done by MRI, can determine inflammation and differentiate from other possible causes. […] EEG, in monitoring brain activity, encephalitis will produce abnormal signal. […] Lumbar puncture (spinal tap), this helps determine via a test using the cerebral-spinal fluid, obtained from the lumbar region. […] Polymerase chain reaction (PCR) testing of the cerebrospinal fluid, to detect the presence of viral DNA which is a sign of viral encephalitis.

• #5 Acute encephalitis – diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6303463/

  Encephalitis, inflammation of the brain, is most commonly caused by a viral infection (especially herpes simplex virus [HSV] type 1 in the UK) although autoimmune causes, such as N-methyl D-aspartate receptor (NMDAR) antibody encephalitis, are increasingly recognised. […] Diagnosis hinges crucially on lumbar puncture and cerebrospinal fluid (CSF) examination, but imaging and electroencephalography (EEG) may also be helpful. […] Undertaking a lumbar puncture is vital to distinguish encephalitis from encephalopathy, and therefore to guide management. […] Aciclovir is a time-critical life-saving treatment for HSV encephalitis and should be commenced before lumbar puncture if this is delayed for any reason. […] Investigation and management of suspected autoimmune encephalitis should be undertaken in consultation with a neurologist.

• #6 Clinical Testing and Diagnosis for St. Louis Encephalitis | St. Louis Encephalitis Virus | CDC

  https://www.cdc.gov/sle/hcp/diagnosis-testing/index.html

  Patients with suspected St. Louis encephalitis should first be tested for St. Louis encephalitis virus-specific immunoglobulin (Ig) M antibodies in serum and/or cerebrospinal fluid (CSF). […] Positive IgM results should be confirmed by neutralizing antibody testing at a state public health laboratory or CDC. […] Serologic testing remains the primary method for diagnosing St. Louis encephalitis. […] Laboratory diagnosis is generally accomplished by testing of serum or CSF to detect St. Louis encephalitis virus-specific IgM and neutralizing antibodies. […] Initial serological testing is performed using IgM capture enzyme-linked immunosorbent assay (ELISA) or by indirect immunofluorescence assay (IFA). […] Because of potential cross-reactivity to other flavivirus infections (e.g., West Nile virus, Powassan virus) or non-specific reactivity, a positive St. Louis encephalitis virus IgM antibody test result should be confirmed by neutralizing antibody testing (plaque-reduction neutralization test) of serum or CSF specimens at a state public health laboratory or CDC.

• #7 Encephalitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encephalitis/diagnosis-treatment/drc-20356142

  To diagnose encephalitis, a member of your healthcare team does a physical exam and takes your medical history. […] Your healthcare professional might then recommend: […] Brain imaging. MRI or CT images can reveal any swelling of the brain or another condition that might be causing your symptoms, such as a tumor. […] Spinal tap, known as a lumbar puncture. A needle inserted into your lower back removes a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds the brain and spinal column. Changes in this fluid can point to infection and inflammation in the brain. Sometimes samples of CSF can be tested to identify the cause. This may include testing for infection or the presence of antibodies associated with autoimmune encephalitis. […] Other lab tests. Samples of blood, urine or excretions from the back of the throat can be tested for viruses or other infectious agents.

• #8 Encephalitis: Causes, Symptoms, & Treatment

  https://www.webmd.com/a-to-z-guides/understanding-encephalitis-basics

  Encephalitis Diagnosis […] Your doctor will ask about your symptoms, including how long you’ve had them. Because people with encephalitis can be disoriented, family and friends are key to getting a good history. It’s important to know if you’ve come into contact with mosquitoes or ticks, infected animals, or sick people. […] Your doctor will also do a physical exam and may order some tests. […] Encephalitis tests […] Some of the tests your doctor may use include: […] Blood tests, including a complete blood count and comprehensive metabolic panel […] Urine, stool, or sputum culture tests to see if you have an infection and what type you have […] Imaging tests, such as CT scans, MRI scans, and magnetoencephalography (MEG) to see where in your brain you are having seizures […] Electroencephalogram (EEG) to look for seizers or specific electrical activity in your brain

• #9 Autoimmune encephalitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/autoimmune-encephalitis/diagnosis-treatment/drc-20576406

  Autoimmune encephalitis diagnosis involves a review of your symptoms, a physical exam and several tests. It’s important to get an accurate diagnosis because autoimmune encephalitis, also known as AE, can be mistaken for other diseases. […] Experts have created autoimmune encephalitis criteria to help healthcare professionals diagnose people with AE. Healthcare professionals look for patterns of symptoms that signal AE. They also test for signs that antibodies are attacking receptors in the brain to cause AE. […] Tests also help rule out other possible causes of your symptoms, such as infections or other autoimmune conditions. […] Sometimes people are incorrectly diagnosed with autoimmune encephalitis. It’s important for healthcare professionals to consider all potential conditions when making a diagnosis.

• #10

  https://www.nhs.uk/conditions/encephalitis/diagnosis/

  The symptoms of encephalitis can have a number of possible causes, so several tests may be needed to diagnose it. […] A lumbar puncture is a procedure to remove some fluid from around the spinal cord (the nerves running up the spine) so it can be checked for signs of encephalitis. […] The sample will be checked for signs of infection or a problem with your immune system, which are the main causes of encephalitis. […] Other tests may include: an electroencephalogram (EEG) where small electrodes are placed on your scalp, which pick up the electrical signals from your brain and show abnormal brain activity. […] tests of your blood, urine or other bodily fluids to check for an infection.

• #11 Autoimmune encephalitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/autoimmune-encephalitis/diagnosis-treatment/drc-20576406

  Testing for autoimmune encephalitis includes checking for antibodies. AE is caused by antibodies in the brain that attack proteins and receptors in the brain and cause symptoms. […] Your healthcare professional also may recommend an MRI of your brain. MRIs can look for signs of autoimmune encephalitis or rule out other causes of your symptoms. […] An electroencephalogram, also known as an EEG, tests the electrical activity in your brain. It may show seizure activity and may help your healthcare professional diagnose AE. An EEG also can help rule out other conditions.

• #12 Encephalitis: Symptoms, causes, risks, treatment, diagnosis

  https://www.medicalnewstoday.com/articles/168997

  Doctors may order several tests to diagnose encephalitis. […] A CT scan may be useful in detecting changes in brain structure. It can also rule out other causes, such as stroke, an aneurysm, or a tumor. However, an MRI is the best imaging option for encephalitis, as doctors can use it to identify the classic brain changes that suggest the condition. […] A lumbar puncture, which takes a sample of cerebrospinal fluid from the spine, might reveal protein levels and white blood cell levels that are higher than expected. […] A doctor might order a blood test if they suspect viral encephalitis.

• #13 Diagnosis – International Autoimmune Encephalitis Society

  https://autoimmune-encephalitis.org/diagnosis/

  Other testing: Magnetic resonance imaging (MRI) of the brain with and without contrast for abnormalities suggestive of autoimmune encephalitis is very useful in patients with limbic encephalitis, usually showing increased FLAIR/T2 signal involving one or both temporal lobes. It is possible that the MRI may be read as normal. FDG-PET is suggested to be more sensitive than MRI and 18fluorodeoxyglucose (18F-FDG) PET imaging has been reported to typically reveal medial temporal lobe hypermetabolism even in MRI-negative or inconclusive cases. The FDG-Pet is particularly important for patients with limbic encephalitis who often have normal or non-specific MRI findings. EEG (often sleep deprived so the neurologist can see how your brain is functioning when it is tired or a 24 hour EEG) possibilities include: e.g., extreme delta brush and generalized rhythmic delta activity in anti-NMDAR encephalitis, low wave activity in temporal lobes, diffuse slowing, and epileptic activity. Any one of these are a possible finding of evidence. […]

• #14 Autoimmune encephalitis: Is FDG PET the key to diagnosis? | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/63/supplement_2/2940

  Autoimmune encephalitis (AE) is a relatively rare neurological disorder, which develops as a rapidly progressive encephalopathy caused by brain inflammation that, when it is diagnosed lately its prognosis is poor reaching up to 7-12% of deaths. […] For patients with AE treatment should be implemented quickly to avoid irreversible sequelae and death, for this reason is important to find an early biomarker for no delaying therapy. […] 18F-FDG-PET has been recognized as a potentially useful biomarker in the initial evaluation and subsequent monitoring of patients with suspected autoimmune encephalitis. […] In our study, 100% patients had abnormal FDG PET, while only 3 had abnormal MRI, suggesting the limited sensitivity of MRI in AE. […] We describe the main findings corresponding to AE, these metabolic patterns can add value to the diagnostic evaluation of AE. […] It is necessary more prospective studies to demonstrate the specificity and accuracy of FDG PET so that this study can be included in the future diagnostic recommendations for AE.

• #15 Acute encephalitis – diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6303463/

  The key to establishing evidence of central nervous system (CNS) inflammation is the analysis of CSF. […] Lumbar puncture (LP) is often excessively delayed, primarily due to performing brain imaging to exclude raised intracranial pressure. […] The key tests that should be requested on CSF are outlined in Fig 1. […] Cerebrospinal fluid PCR for HSV has a sensitivity and specificity of over 95% for HSV encephalitis in immunocompetent adults. […] The management of autoimmune encephalitis with immune therapy is non-standardised and based on evidence from retrospective studies. […] The role of brain biopsy in the diagnosis of encephalitis has declined since the advent of PCR testing in CSF and it does not form part of the initial assessment.

• #16 Diagnosis – International Autoimmune Encephalitis Society

  https://autoimmune-encephalitis.org/diagnosis/

  At symptom presentation, about 80% of patients with autoimmune encephalitis have mild-to-moderate CSF lymphocytic pleocytosis (usually <100 white blood cells/μl), 30% have mild-to-moderate increase of protein concentration, and 50–60% have oligoclonal bands. These bands can be present even when routine CSF studies are normal. Combined abnormal CSF WBC count, protein, and oligoclonal bands are more likely when a shorter time between symptomatic-onset-to-Lumbar puncture occurs. In contrast to most autoimmune encephalitis, the limbic encephalitis associated with LGI1-specific antibodies frequently occurs with normal or minimal CSF findings. [...] [...] Diagnosis is confirmed through lab testing for antibodies known to cause these disorders; it is recommended that blood (serum) be tested at the same time as the spinal fluid is tested. However, some of these tests have been found to be less reliable than CSF testing. Cerebral spinal fluid (CSF) is 100% sensitive and 100% accurate when testing for NMDA. For example, where blood or serum testing can give a false reading as the sensitivity of finding Anti-NDMA antibodies in serum is only ~75% with a 97%+ specificity. This means you may miss about 25% of cases. So, if there is a high index of suspicion, even if the serum test is negative, a CSF sample should be acquired and evaluated. Negative results in antibody testing does NOT rule out a diagnosis of autoimmune encephalitis. This is because not all antibodies in autoimmune encephalitis have been discovered yet. If the antibody test comes back negative and the patient has all the other findings confirming AE, the patient is considered to have seronegative AE aka antibody-negative AE. [...]

• #17 Diagnosis and management of acute encephalitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4121461/

  Encephalitis results from inflammation of the brain parenchyma, and may be caused by infections or autoimmune conditions. Diagnosis is typically made by a combination of clinical, laboratory, neuroimaging, and electrophysiologic findings. A number of case definitions have been developed, which generally require encephalopathy, as characterized by alteration in consciousness or personality change lasting for a sustained period of time (typically greater than 24 hours). To distinguish encephalitis from other causes of encephalopathy, key features include presence of fever, CSF pleocytosis, or MRI or EEG changes compatible with encephalitis. […] A practical approach to diagnosis in adults is presented. In addition to routine studies to investigate for causes of encephalopathy, all patients with suspected encephalitis should undergo blood cultures and HIV testing.

• #18 Encephalitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/436

  1st investigations to order include FBC, peripheral blood smear, serum electrolytes, liver function tests, blood cultures, throat swab, nasopharyngeal aspirate, chest radiography, CT brain, MRI brain, electroencephalogram (EEG), cerebrospinal fluid (CSF) analysis, CSF culture, CSF serology, and CSF polymerase chain reaction (PCR).

• #19 Diagnosis and management of acute encephalitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4121461/

  Since herpes simplex virus (HSV), varicella-zoster virus (VZV), and enterovirus are 3 of the most commonly identified etiologic agents in acute encephalitis, these should be routinely screened for in the CSF. […] The diagnostic approach provided above may require days to weeks to ascertain a specific etiologic basis for treatment. At the time of presentation, it is important to consider empiric management for common etiologies of encephalitis. Foremost is HSV and the need to start IV acyclovir as early as possible. Delay in acyclovir treatment in those suspected with HSV infection resulted in increased risk of death and severe disability.

• #20 Encephalitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/encephalitis/

  Encephalitis is the inflammation of brain parenchyma with neurological dysfunction. […] Diagnosis is based on laboratory studies (serology, CSF analysis) and brain MRI. […] Initial testing includes serum and CSF tests for common and treatable causes of encephalitis. […] Evaluation for malignancy is indicated in all patients with proven or suspected autoimmune encephalitis. […] Brain biopsy may be considered if the cause of encephalitis remains unknown. […] Suspect encephalitis in any patient with altered mental status of unknown cause. […] Initial investigations (all patients) include routine laboratory studies (CBC, CMP, blood cultures) and HIV testing, lumbar puncture (LP) if no contraindications to LP, brain imaging (ideally MRI with IV contrast), EEG, and serum and CSF tests for common and treatable causes of encephalitis.

• #21 Encephalitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/436?locale=it

  Encephalitis is a pathologic state of brain parenchymal inflammation leading to an altered state of consciousness or focal neurologic signs. […] Initial investigations should always include blood cultures, neuroimaging (preferably magnetic resonance imaging), and cerebrospinal fluid analysis (unless contraindicated). […] Diagnostic tests include CBC, peripheral blood smear, serum electrolytes, liver function tests, blood cultures, throat swab, nasopharyngeal aspirate, chest radiography, CT brain, MRI brain, electroencephalogram (EEG), cerebrospinal fluid (CSF) analysis, CSF culture, CSF serology, and CSF polymerase chain reaction (PCR). […] Tests to consider include stool enteroviral culture, sputum culture, IgG and IgM antibodies (blood or CSF), PCR (blood), HIV serology/RNA test, CSF biomarkers/prion protein assay, paraneoplastic antibodies (blood and CSF), abdominal/pelvic ultrasound, whole-body CT, whole-body PET scans, magnetic resonance spectroscopy, next-generation sequencing of CSF, and brain biopsy.

• #22 Encephalitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encephalitis/diagnosis-treatment/drc-20356142

  Electroencephalogram (EEG). Electrodes attached to your scalp record the brain’s electrical activity. Certain patterns may point to encephalitis. […] Body imaging. Sometimes, autoimmune encephalitis may be triggered by an immune response to a tumor in the body. The tumor may be noncancerous or cancerous. Your healthcare professional may order imaging studies, such as ultrasound, MRI, CT or PET-CT scans. These scans may look at your chest, stomach area or pelvis to check for these tumors. If a mass is found, a small piece of it may be removed to study it in a lab. This is known as a biopsy. […] Brain biopsy. Rarely, a small sample of brain tissue might be removed for testing. A brain biopsy is usually done only if symptoms are worsening and treatments are having no effect.

• #23

  https://journals.lww.com/jnsm/fulltext/2020/03010/laboratory_diagnosis_of_encephalitis__new_insights.2.aspx

  Nowadays, the role of brain biopsy in the diagnosis of encephalitis has declined since the advent of polymerase chain reaction (PCR) testing in CSF, and it does not form a part of the initial assessment. […] The role of CSF PCR in the diagnosis of viral infections of the nervous system has been extensively reviewed. […] The specificity and sensitivity of some PCR assays such as that for HSV-1 DNA are exceptionally high at 96% and 99%, respectively; other assays are not as robust. […] If tests for an infective cause are negative, or if patients present with a recognizable phenotype of autoimmune encephalitis at the outset, then autoantibody testing should be considered. […] Despite thorough investigation for infective and autoimmune causes, between one-third and two-thirds of encephalitis cases do not have an etiological agent detected. […] The implementation of advanced genomic techniques such as multiplex PCR and NGS requires extensive laboratory validation and standardization to avoid any misleading result due to contamination or nonspecific reaction.

• #24 Diagnosis – International Autoimmune Encephalitis Society

  https://autoimmune-encephalitis.org/diagnosis/

  Due to the diversity of potential infections, recent research by Dr. Eric Lancaster at UPENN suggests advanced genetic techniques occur (e.g., metagenomic deep sequencing of cerebral spinal fluid) which have been proposed to screen for thousands of pathogens rapidly and efficiently. This approach should assume a wider role in diagnosing unusual central nervous system (CNS) infections in the coming years. At this point in the investigation, the clinician has been able to rule out if the patient has a viral encephalitis or bacterial encephalitis and the investigation continues to determine if the patient could have autoimmune encephalitis. […] […] Time. If the patient doesn’t develop neurological symptoms within 4 weeks after onset of psychiatric symptoms, then the diagnosis of Autoimmune Encephalitis becomes very unlikely. […]

• #25 Differential Diagnosis of Meningitis and Encephalitis

  https://www.neurologylive.com/view/differential-diagnosis-meningitis-and-encephalitis

  The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. […] Initial diagnostic testing should be directed at excluding life-threatening, common, and treatable etiologies; further work up should be focused on the temporal pattern of the illness, clinical clues, and epidemiological risk factors. […] Encephalitis is defined by major and minor criteria. […] The main differential for encephalitis includes infectious (viruses being the most common), and autoimmune etiologies. […] Evaluation includes an initial HSV polymerase chain reaction on the CSF as well as immediate treatment with empiric intravenous acyclovir. […] It is essential that the workup for a patient with meningitis or encephalitis begins with a thorough history and physical exam.

• #26 Diagnosis – International Autoimmune Encephalitis Society

  https://autoimmune-encephalitis.org/diagnosis/

  Next, other medical causes are excluded some that present similarly to autoimmune encephalitis are Wernicke encephalitis, Intoxications such a neuroleptic malignant syndrome and serotonin syndrome, lymphoma or carcinomatous meningitis may present similarly to autoimmune encephalitis. […] […] The syndromes that the patient presents with, are clues to the clinician as to what is occurring as is the age and gender of the patient. For example, Approximately 60% of patients with autoimmune encephalitis have prodromal low-grade fever, malaise, or headache. Some prodromal symptoms are characteristic of particular types of autoimmune encephalitides. Faciobrachial dystonic seizures and paroxysmal dizzy spells occur with LGIl. Severe diarrhea and weight loss occur in the prodromal phase of anti-DPPX encephalitis. Myoclonus (sudden, involuntary jerking of a muscle or group of muscles) can occur with LGI1, DPPX antibody and the paraneoplastic antibody Anti-Ri (Anna 2). In these examples, an experienced clinician in autoimmune encephalitis may have a high suspicion of a specific type of AE based on your presenting symptoms and the history of how your illness began. […]

• #27 Encephalitis Workup: Approach Considerations, Blood and Urine Tests, Studies to Identify Infectious Agent

  https://emedicine.medscape.com/article/791896-workup

  Although bacterial, fungal, and autoimmune disorders can produce encephalitis, most cases are viral in origin. […] A lumbar puncture (LP) should be performed on all patients suspected of having a viral encephalitis. […] The most important diagnostic test in the emergency department (ED) to rule out bacterial meningitis is prompt Gram staining and, if available, polymerase chain reaction (PCR) of the CSF in patients with suspected HSV encephalitis. […] Although most histologic features are nonspecific, brain biopsy is the criterion standard because of its 96% sensitivity and 100% specificity.

• #28 Autoimmune Encephalitis: A Physician’s Guide to the Clinical Spectrum Diagnosis and Management

  https://www.mdpi.com/2076-3425/12/9/1130

  The diagnosis of autoimmune encephalitis can be challenging due to the wide spectrum of clinical presentations, prevalence of psychiatric features that mimic primary psychiatric illnesses, frequent absence of diagnostic abnormalities on conventional brain MR-imaging, non-specific findings on EEG testing, and the lack of identified IgG class neuronal autoantibodies in blood or CSF in a subgroup of patients. […] Thus, the diagnosis requires a high index of clinical suspicion after reasonable exclusion of alternative causes and a lower threshold to test paired CSF/serum for confirmation of the presence of neuronal autoantibodies, particularly in those with red flags suggestive of underlying autoimmunity. […] The challenge of establishing a diagnosis is greatest in those cases where neuronal autoantibodies are not identified in the CSF, despite a very high index of clinical suspicion and a reasonable exclusion of alternative etiologies including infectious etiologies.

• #29 Autoimmune Encephalitis: A Physician’s Guide to the Clinical Spectrum Diagnosis and Management

  https://www.mdpi.com/2076-3425/12/9/1130

  The diagnosis of autoimmune encephalitis usually follows the 2016 autoimmune encephalitis criteria by Graus et al. […] Diagnostic workup for individuals suspected to have autoimmune encephalitis includes screening of paired serum and CSF samples for the presence of IgG class anti-neuronal antibodies, tumor screening, CSF biomarkers of inflammation or immune activation, serum biomarkers for systemic autoimmune disorders, brain neuroimaging, brain 18Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), EEG abnormalities, clinically meaningful response to immunotherapy trials, and the diagnostic utility of brain biopsy.

• #30 SciELO Brazil – Autoimmune encephalitis: a review of diagnosis and treatment Autoimmune encephalitis: a review of diagnosis and treatment

  https://www.scielo.br/j/anp/a/mqLMtVDZLLF566CwstHwyhy/

  Autoimmune encephalitis (AIE) is one of the most common causes of noninfectious encephalitis. […] We reviewed common forms of AIE and discuss their diagnostic approach and treatment. […] Autoimmune encephalitis is typically an acute or subacute onset and that may become chronic later. […] We reviewed common causes of AIE and discuss their pathophysiology, diagnostic approach and management. […] Table 1 summarizes the diagnostic criteria for limbic encephalitis. […] For improving the recognition of immune-mediated cases, diagnostic criteria for suspected AIE were recently established including criteria for seronegative AIE. […] Definite soropositive AIE requires typical clinical picture and positive anti-neuronal antibodies. […] The diagnosis should not rely solely on antibody testing as patients with AIE may be seronegative. […] Clinicians must be aware of the different laboratory assessment methods available as well as proper interpretation of results. […] Patients benefit from early aggressive treatment and relapses may occur.

• #31 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Autoimmune-encephalitis-Diagnosis.aspx

  A patient may be said to be possibly suffering from AIE if all three of the criteria below are met: Subacute onset of impairment of working or short-term memory, alteration in mental status, or psychiatric symptoms; Alternative diagnoses can be excluded with reasonable confidence; One or more of the following: New focal findings relating to the CNS, Unexplained seizures, CSF pleocytosis (more than 5 WBC/cu. mm), MRI findings which suggest encephalitis. […] MRI imaging of the brain is usually nonspecific, or even normal, but limbic encephalitis usually produces some characteristic changes in the medial temporal lobe. EEG testing is also nonspecific except for the extreme delta brush pattern seen in some cases of NMDAR encephalitis, but it may help rule out other disorders, or show the presence of some special seizure disorders such as subclinical seizures, or non-convulsive status epilepticus.

• #32 Anti-NMDA Receptor Autoimmune Encephalitis: Diagnosis and Management S | IJGM

  https://www.dovepress.com/anti-nmda-receptor-autoimmune-encephalitis-diagnosis-and-management-st-peer-reviewed-fulltext-article-IJGM

  Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most recognized form of autoimmune encephalitis. It is characterized by a constellation of neurologic and psychiatric features along with positive NMDAR antibody, which is more sensitive and specific in CSF than serum. All patients should be screened at least once for neoplasm, with ovarian teratoma being found in most tumor-related cases. […] To improve the clinical recognition of anti-NMDAR encephalitis, a group of experts in 2016 developed a set of diagnostic criteria in which a diagnosis of probable anti-NMDAR encephalitis can be made when all three of the proposed criteria are met. […] A definite diagnosis can be made in the presence of one or more of the six major group of symptoms proposed by Graus et al and positive NMDAR antibodies. Demonstration of IgG antibodies against the NR1 subunit of the NMDA receptor in the CSF is more sensitive and specific than serum testing for anti-NMDAR antibodies. […] The presence of NMDA antibody is critical to confirming the diagnosis, but there is limited clinical utility in following antibody titers during the disease. […] After recovery, most patients still have antibodies in serum and CSF.

• #33 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Autoimmune-encephalitis-Diagnosis.aspx

  In several of the AIE the encephalitis is triggered by autoantibodies produced in response to a tumor elsewhere, as in anti-NMDAR or anti-Hu antibodies. Tumor detection is therefore an urgent and necessary task, both to treat the cancer and so prevent further antibody production, and to make sure that the immunotherapy does not interfere with cancer diagnosis or treatment at a later stage.

• #34 Table 1: Diagnostic Criteria for Encephalitis and Encephalopathy of Presumed Infectious or Autoimmune Aetiology (extracted from Venkatesan et al. )

  https://clinmedjournals.org/articles/ijcc/ijcc-2-042table1.html

  Patients presenting to medical attention with altered mental status (defined as decreased or altered level of consciousness, lethargy or personality change) lasting ≥24 h with no alternative cause identified. […] Confirmed encephalitis requires one of the following: (1) Pathologic confirmation of brain inflammation consistent with encephalitis; (2) Defined pathologic, microbiologic, or serologic evidence of acute infection with a microorganism strongly associated with encephalitis from an appropriate clinical specimen; or (3) Laboratory evidence of an autoimmune condition strongly associated with encephalitis.

• #35 Autoimmune Encephalitis Diagnosis | AE Alliance

  https://aealliance.org/patient-support/diagnosis/

  Because of the time it takes to get the results of all tests and also because early treatment for AE helps people get better faster, many experts recommend starting treatment in children or adults who may have AE, or who meet the criteria for “possible AE”. If test results in a person who was thought to have “possible AE” do not fit with this diagnosis, then they should continue being tested for other conditions that may cause similar symptoms. It is important not to confuse “possible AE” with an actual diagnosis of AE. […] Experts have developed criteria for “possible AE”, “definite antibody-positive AE” and “probable antibody-negative AE” in adults and children. […] In adults, a diagnosis of “possible AE” is made when all three of the criteria listed below have been met: Subacute onset (rapid progression of symptoms over less than 3 months) of working memory problems (short-term memory loss), altered mental state (such as confusion or decreased ability to interact with other people or surroundings), or psychiatric symptoms (such as hallucinations).

• #36 Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults | Canadian Journal of Neurological Sciences | Cambridge Core

  https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/canadian-consensus-guidelines-for-the-diagnosis-and-treatment-of-autoimmune-encephalitis-in-adults/DC88204486B656B85324E93AF2CCCFC7

  Diagnostic criteria for AIE were first proposed by Graus et al. in 2016. […] An AIE diagnosis can be classified according to the degree of diagnostic certainty including possible, probable, and definite. […] While the diagnostic criteria can be helpful in identifying patients in whom a diagnosis of AIE should be considered, they also serve to identify those patients in whom AIE is less likely. […] In cases where criteria are met only for possible AIE after investigations including neural antibody testing are complete, early involvement of a specialist in autoimmune neurology is important. […] Once AIE is suspected, clinicians need to work towards obtaining evidence supporting this diagnosis and exclude mimics. […] Recommended for all patients are cerebrospinal fluid (CSF) examination, brain magnetic resonance imaging (MRI), electroencephalography (EEG), and panel-based neural antibody testing.

• #37 Diagnostics in infectious encephalitis | Encephalitis International

  https://www.encephalitis.info/diagnosis-of-encephalitis/diagnostics-in-infectious-encephalitis/

  Diagnostic tests used in encephalitis can be split into two broad categories: Laboratory tests, which analyse samples from patients such as cerebrospinal fluid, blood, urine and other body fluids. […] This is the vital test to establish a diagnosis of encephalitis. […] All patients suspected of encephalitis should have a lumbar puncture as soon as possible unless there is a clear reason preventing it from taking place. […] Various laboratory tests are performed on CSF. […] Diagnosing encephalitis can be challenging and there is no single test which will give patients and doctors an answer. […] The doctor will analyse the laboratory results as well as considering the results of other tests (imaging, EEG), the patients condition and the response to treatment. […] The diagnostic test can help to confirm a diagnosis when a direct cause is found (there is evidence the pathogen has caused the inflammation), can make a probable diagnosis (when all tests and clinical features suggest a cause and treatment seems to be efficient) or a diagnosis of encephalitis with an unknown cause. […] There are many factors which make establishing an encephalitis diagnosis challenging.

• #38 Autoimmune Encephalitis Misdiagnosis   – Insights

  https://news.mayocliniclabs.com/2023/02/20/autoimmune-encephalitis-misdiagnosis/

  Autoimmune encephalitis is a rare condition, and it’s important to remember that many of the mimics are much more common. […] There’s been many studies on patients in whom the initial diagnosis of autoimmune encephalitis was overlooked, and they eventually had a true diagnosis of autoimmune encephalitis. […] Overall, we found that autoimmune encephalitis misdiagnosis occurred in just over a quarter of the referrals, and the median age was 48 years, and a slight majority were female. […] To meet autoimmune encephalitis diagnostic criteria, you have to fulfill what we term here, the possible autoimmune encephalitis diagnostic criteria, and then there’s an algorithm where you may fit into other categories. […] In our study, just 28% fulfilled these diagnostic criteria. […] We looked at the most common reasons for misdiagnosis, and the major one was overinterpretation of a nonspecific serum antibody.

• #39

  https://journals.lww.com/jnsm/fulltext/2020/03010/laboratory_diagnosis_of_encephalitis__new_insights.2.aspx

  Encephalitis is a serious clinical syndrome, which presents with a wide range of severity. […] In this review, we cover the various clinical presentations of this syndrome and provide an overview of laboratory testing that can be performed in routine clinical microbiology laboratories and reference laboratories. […] Recently, the advance in medical care and advancing age of our patient population, as well as increased number of immunocompromised conditions either due to post chemotherapy, human immunodeficiency virus, transplant and autoimmune diseases complicated both clinical and laboratory diagnosis of encephalitis. […] Other noninfectious differential diagnoses of encephalitis should be ruled out with appropriate tests. […] The most essential investigation for the diagnosis of CNS infection in all suspected patients is cerebrospinal fluid (CSF) analysis or brain tissue obtained at either brain biopsy or autopsy.

• #40 Encephalitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/encephalitis/

  A normal CSF analysis does not exclude encephalitis. […] CSF PCR may be falsely negative early in the course of HSV encephalitis. […] Always consider HSV encephalitis if imaging shows temporal lobe involvement; bilateral temporal lobe abnormality is pathognomonic. […] Additional testing is guided by infectious diseases and neurology based on clinical features, exposures, risk factors, and local epidemiology. […] Consult neurology and infectious diseases immediately. […] Initiate immediate empiric antimicrobial therapy for encephalitis before diagnostic confirmation. […] Once etiology is known, tailor cause-specific management under specialist guidance. […] If clinical suspicion is high, consider empiric therapy prior to diagnostic confirmation once infectious causes are excluded.

• #41 Differential Diagnosis of Meningitis and Encephalitis

  https://www.neurologylive.com/view/differential-diagnosis-meningitis-and-encephalitis

  Initial studies include opening pressure, glucose, protein, cell count with differential, gram stain and culture, and oligoclonal bands. […] Pathogen-specific polymerase chain reaction testing is the current diagnostic method for infections, however next-generation sequencing holds promise for rapid unbiased detection of unknown pathogens. […] MRI is an important diagnostic tool and should be done with gadolinium if renal function allows. […] An electroencephalogram can be helpful if the patient is confused, obtunded, or comatose to rule out non-convulsive status epilepticus. […] For suspected encephalitis, empiric acyclovir (10 mg/kg IV every 8 hours) coverage for HSV should be continued until a negative CSF polymerase chain reaction is confirmed or a second negative polymerase chain reaction in the setting of strong clinical suspicion.

• #42 Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults | Canadian Journal of Neurological Sciences | Cambridge Core

  https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/canadian-consensus-guidelines-for-the-diagnosis-and-treatment-of-autoimmune-encephalitis-in-adults/DC88204486B656B85324E93AF2CCCFC7

  There is no widely accepted definition of treatment failure or refractory disease in autoimmune encephalitis. […] We define treatment failure in patients with AIE as lack of improvement or worsening 5-10 days after initiation of first-line treatment in severe AIE and 2-4 weeks after initiation of first-line treatment in mild/moderate AIE. […] Relapse in AIE is not uncommon, and characteristics demonstrate significant variability between AIE subtypes. […] For acute treatment of relapse, we suggest following the first-line and/or second-line treatment algorithm as appropriate unless a patient is known to have failed a particular therapy in the past. […] Given the complexities in both the acute and chronic management of AIE, early referral to a center with expertise in managing AIE and access to PLEX is recommended, especially in patients who do not respond to first-line therapy.

• #43 Encephalitis: Causes, Symptoms, & Treatment

  https://www.webmd.com/a-to-z-guides/understanding-encephalitis-basics

  Spinal tap (lumbar puncture) to remove cerebrospinal fluid to find infections in your brain or spinal cord […] A neurological exam, which is a series of tests that show how well your nervous system is working […] An intracranial pressure monitoring (ICP) to measure the pressure inside your skull […] Rarely, a biopsy of your brain tissue to look at under a microscope […] […] […] Encephalitis is a condition that involves inflammation and brain swelling. It’s usually caused by infection with a virus, especially HSV. It isnt always preventable, but you can lower your risk by avoiding infection with a germ that could lead to encephalitis. This means getting your recommended vaccines and avoiding or protecting yourself when in areas that have ticks and mosquitoes. If you have signs or symptoms of encephalitis, you should get to the doctor right away. Quick diagnosis and treatment can make your recovery easier and limit lasting effects. Although some people do experience complications, most people fully recover.

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