Autoimmune encephalitis, Hashimoto. MR of the brain. Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. Open

Definition

Autoimmune encephalitis is a disease in which the immune system attacks the brain. The symptoms are increasing over days-weeks. Some cases are related to other autoimmune diseases, including Systemic lupus erythematosus (SLE) or autoimmune metabolic disease (Hashimoto's thyroiditis). Others may have a underlying cancer.

• There are several types of autoimmune encephalitis that are separated by symptoms, antibody in blood and spinal fluid and other examination findings
• The disease must be investigated and treated by a neurologist

Symptoms

• Headache
• Mentaly unclear
• Hallucinations
• Aggressiveness
• Memory impairment
• Convulsions

Examinations

• MR of brain and brain stem
• PET / CT of the brain
• EEG
• Spinal Fluid
• Antibody in blood (serum) and spinal fluid
  • In a large part of the cases, more or less typical antibody tests may turn out positive. However, low titer results must be interpreted with caution because "false positive" results are irrelevant.
  • The antibodies are directed to proteins in central nervous system (CNS). These can be membrane receptors og ion channel associated proteins on the surface of neurons
  • Thyroid antibody (anti-TPO) by Hashimoto's thyroiditis og Hashimoto Encephalitis (SREAT)

Diagnosis

• Disease history
• Examinations
• Exclude infections and other

Incorrect diagnosis (similar conditions, differential diagnoses)

• Virus encephalitis

  • Herpes simplex
  • Enterovirus
  • West Nile Virus
  • Ebstein-Barr Virus (EBV)
•  

• Bacterial infection

  • Listeria
  • Streptococcus
  • Syphilis
  • Borrelia/Lyme disease
  • Tuberkulosis (Tbc)

• Mushroom infection (in weakened immune system due to medication or HIV)

  • Cryptococcus
  • Aspergillus
• More comprehensive list of infections that can attack the brain here (Wikipedia)

• CNS vasculitis (in the blood vessels of the brain)

• Systemic lupus erythematosus (SLE) with affection of the brain

• Wernicke encephalitis

  • Alcoholism
  • Reduced nutritional status

• intoxication

• Lymphoma

• Carcinomatic meningitis

Literature

• Lancaster E, 2016
• Wikipedia

• Bindevevssykdommer.no
• Vaskulitt.no