Autoimmune Encephalitis in the ICU: Analysis of Phenotypes, Serologic Findings, and Outcomes

Neurocritical Care
Manoj K MittalAndrew McKeon

Abstract

To report the clinical and laboratory characteristics, clinical courses, and outcomes of Mayo Clinic, Rochester, MN, ICU-managed autoimmune encephalitis patients (January 1st 2003-December 31st 2012). Based on medical record review, twenty-five patients were assigned to Group 1 (had ≥1 of classic autoimmune encephalitis-specific IgGs, n = 13) or Group 2 (had ≥3 other characteristics supporting autoimmunity, n = 12). Median admission age was 47 years (range 22-88); 17 were women. Initial symptoms included ≥1 of subacute confusion or cognitive decline, 13; seizures, 12; craniocervical pain, 5; and personality change, 4. Thirteen Group 1 patients were seropositive for ≥1 of VGKC-complex-IgG (6; including Lgi1-IgG in 2), NMDA-R-IgG (4), AMPA-R-IgG (1), ANNA-1 (1), Ma1/Ma2 antibody (1), and PCA-1 (1). Twelve Group 2 patients had ≥3 other findings supportive of an autoimmune diagnosis (median 4; range 3-5): ≥1 other antibody type detected, 9; an inflammatory CSF, 8; ≥1 coexisting autoimmune disease, 7; an immunotherapy response, 7; limbic encephalitic MRI changes, 5; a paraneoplastic cause, 4; and diagnostic neuropathological findings, 2. Among 11 patients ICU-managed for ≥4 days, neurological improvements were attributable to cortic...Continue Reading

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Citations

Aug 24, 2016·American Journal of Respiratory and Critical Care Medicine·Etienne de MontmollinUNKNOWN ENCEPHALITICA Study Group ‡
Feb 12, 2017·AJNR. American Journal of Neuroradiology·B P KelleyB Griffith
Feb 6, 2018·Current Opinion in Critical Care·Divyanshu DubeyAndrew McKeon
Apr 6, 2018·Anesthesiology·Miles BergerJoseph P Mathew
Dec 6, 2018·Continuum : Lifelong Learning in Neurology·Alejandro A Rabinstein
Sep 27, 2019·Intensive Care Medicine·R SonnevilleJ Honnorat
Dec 21, 2018·Neurology. Neuroimmunology and Neuroinflammation·Julia SchubertUNKNOWN GENERATE and IGNITE network
Aug 29, 2019·Medizinische Klinik, Intensivmedizin und Notfallmedizin·A GüntherD Brämer
Sep 10, 2020·Seminars in Neurology·Rachael A Scott, Alejandro A Rabinstein
Jul 18, 2018·Clinical Neuroradiology·Arndt-Hendrik SchievelkampElke Hattingen
Dec 19, 2018·Journal of Neurology·Osvaldo Laurido-SotoGregory S Day
Aug 15, 2017·Frontiers in Immunology·Gayane HarutyunyanJohann Sellner
Sep 12, 2018·Neurocritical Care·Tanuwong ViarasilpaStephan A Mayer
Jan 31, 2020·Continuum : Lifelong Learning in Neurology·Alejandro A Rabinstein
Aug 23, 2020·Journal of Clinical Medicine·Rosa Rössling, Harald Prüss
Oct 4, 2020·Neurology. Neuroimmunology and Neuroinflammation·Aiqing LiZhen Hong
Mar 3, 2021·Journal of Neurology, Neurosurgery, and Psychiatry·Hesham AbboudUNKNOWN Autoimmune Encephalitis Alliance Clinicians Network
Apr 27, 2021·Neurologic Clinics·Amra Sakusic, Alejandro A Rabinstein
Sep 12, 2017·Journal of Neuroimmunology·Anusha K YeshokumarJohn C Probasco
May 25, 2021·Journal of the Intensive Care Society·Dustin AndersonPeter G Brindley
Jan 25, 2019·Neurology·Jesse CohenArun Venkatesan

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