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Publications

Journal Article Epublish 1 citation

PubMed: 42318510 DOI: 10.1093/braincomms/fcag193

Acute and longitudinal magnetic resonance imaging abnormalities in antibody-mediated encephalitis.

Brain Commun 8(3):fcag193

Authors: Nabil Seery, Paul Beech, Robb Wesselingh, Mark Schoenwaelder, James Broadley, Laurie McLaughlin, Tiffany Rushen, Liora Ter Horst, Andrew Duncan, Tracie Tan, Christina Kazzi, Genevieve Skinner, Cassie Nesbitt, Katherine Buzzard, Wendyl J D'Souza, Yang Tran, Anneke van der Walt, Amy Halliday, Mirasol Forcadela, Bruce Taylor, Andrew Swayne, Amy Brodtmann, David Gillis, Ernest G Butler, Tomas Kalincik, Udaya Seneviratne, Richard A Macdonell, Sudarshini Ramanathan, Stefan Blum, Charles B Malpas, Stephen W Reddel, Todd A Hardy, Terence J O'Brien, Paul Sanfilippo, Helmut Butzkueven, Mastura Monif

Affiliations

  • Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria 3004, Australia.
  • Department of Neurology, Alfred Health, Melbourne, Victoria 3004, Australia.
  • Department of Radiology, Alfred Health, Melbourne, Victoria 3004, Australia.
  • Department of Radiology, Monash Health, Clayton, Victoria 3168, Australia.
  • Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.
  • School of Medicine, The University of Queensland, UQ, Herston, Queensland 4006, Australia.
  • Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria 3065, Australia.
  • Department of Neuroscience, Barwon Health, Geelong, Victoria 3220, Australia.
  • Department of Neurosciences, Eastern Health, Box Hill, Victoria 3128, Australia.
  • Department of Pathology, St Vincent's Hospital, Fitzroy, Victoria 3065, Australia.
  • Department of Neurology, Austin Health, Heidelberg, Victoria 3084, Australia.
  • Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania 7000, Australia.
  • Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria 3052, Australia.
  • Division of Immunology, Pathology Queensland Central Laboratory, Herston, Queensland 4006, Australia.
  • Department of Neurology, Peninsula Health, Frankston, Victoria 3199, Australia.
  • Department of Medicine, CORE, The University of Melbourne, Parkville, Victoria 3010, Australia.
  • Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria 3000, Australia.
  • Department of Neuroscience, Monash Health, Clayton, Victoria 3168, Australia.
  • Department of Neurology and Concord Clinical School, Concord Hospital, Concord, New South Wales 2139, Australia.
  • Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales 2145, Australia.
  • Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria 3052, Australia.
  • Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria 3052, Australia.
  • Brain and Mind Centre, University of Sydney, Camperdown, New South Wales 2050, Australia.

Abstract

Brain magnetic resonance imaging (MRI) abnormalities are an important finding in the evaluation of patients with suspected autoimmune encephalitis (AE). There have been few studies evaluating the frequency and prognostic significance of MRI abnormalities, especially hippocampal swelling, in anti-N-methyl-D-aspartate receptor (NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) Ab-mediated encephalitides. We conducted a multi-centre, retrospective study involving adult patients with confirmed antibody-mediated encephalitis and at least one MRI scan from 10 Australian hospitals (n = 139). MRI scans were evaluated by a neuroradiologist blinded to the specific autoimmune encephalitis diagnosis. We evaluated associations between acute MRI abnormalities (e.g. hippocampal swelling) with 12-month function (modified Rankin scale, mRS ≥2 = worse outcome) and radiological findings. In patients with anti-LGI1 Ab-mediated encephalitis, we identified hippocampal swelling on initial MRI to be associated with worse function at 12 months (OR 0.03; 95% CI 0.003, 0.34; P = 0.005). We found initial AE-associated T2/fluid attenuated inversion recovery (FLAIR) hyperintensities were not associated with 12-month mRS in either the anti-NMDAR (OR 0.39; 95% CI 0.04, 3.97; P = 0.42) or anti-LGI1 Ab-mediated encephalitis groups (OR 0.34; 95% CI 0.07, 1.57; P = 0.17). In anti-LGI1 Ab-mediated encephalitis, both hippocampal swelling (OR 5.76; 95% CI 1.14, 29.02; P = 0.03) and T2/FLAIR hyperintensity (OR 6.81; 95% CI 1.28, 36.22; P = 0.03) were related to the development of mesial temporal atrophy and hippocampal sclerosis. Acute hippocampal swelling is associated with worse outcomes in anti-LGI1 Ab-mediated encephalitis and, alongside initial T2/FLAIR hyperintensity, is associated with the development of both mesial temporal atrophy and hippocampal sclerosis.

MeSH

Sclerosis, Atrophy, Magnetic Resonance Imaging, Encephalitis, Hippocampal Sclerosis