Differentiating Anti-NMDA receptor encephalitis from other diseases: Difference between revisions
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==Overview== | ==Overview== | ||
In the differential diagnosis of anti-NMDA encephalitis, other autoimmune encephalitides with specific antibody associations should be considered, including those associated with antibodies against AMPA receptors, GABA-B receptors, LGI1, Caspr2, and MOG. Clinical and serological evaluations are crucial for accurate diagnosis and appropriate management. | |||
==Differentiating Anti-NMDA Receptor Encephalitis from other Diseases== | ==Differentiating Anti-NMDA Receptor Encephalitis from other Diseases== | ||
{| class="wikitable" | |||
|- | |||
! Antigen | |||
! NMDA receptor NR1 | |||
! Lgil | |||
! CASPR2 | |||
! AMPA receptor | |||
! GABA B receptor | |||
! Glycine receptor | |||
! MgluR5 | |||
|- | |||
| Age(median)/gender female : male | |||
| 0·6–85 (21) 4:1 | |||
| 30–80 (60) 1:2 | |||
| 46–77 (60) 1:4 | |||
| 38–87 (60) 9:1 | |||
| 24–75 (62) 1:1 | |||
| 5–69 (43) 6:5 | |||
| 46, 15 1:1 | |||
|- | |||
| Clinical syndrome | |||
| 1.Prodromal Syndrome | |||
2. Psychiatric Syndrome, seizures, amnesia | |||
3.Movement disorders catatonia, autonomic instability, | |||
|Limbic encephalitis, tonic or facio-brachial dystonic seizures, | |||
myoclonus | |||
| Morvan Syndrome, encephalitis, neuromyotonia | |||
| Limbic encephalitis, psychiatric syndrome | |||
| Limbic encephalitis | |||
| Encephalomyelitis with rigidity and myoclonus, hyperekplexia, stiff-person syndrome, | |||
(retinopathy) | |||
| Limbic encephalitis, myoclonus | |||
|- | |||
| MRI T2/FLAIR hyperintensities, medial temporal | |||
| 25% | |||
| 80% | |||
| 40% | |||
| 90% | |||
| 70% | |||
| 10% | |||
| 50% | |||
|- | |||
| CSF pleocytosis or Oligoclonal Bands | |||
| 95% | |||
| 40% | |||
| 25% | |||
| 90% | |||
| 90% | |||
| some oligoclonal bands | |||
| 2/2 only cases reported and present in them | |||
|} | |||
ocb: oligoclonal bands; EEG: electroencephalograph; NMDA: N-methyl-D-aspartate; AMPA: α-amino-3-hydroxy-5-methyl-4-isoxazol-propionic acid; GABA: | |||
γ-amino-butyric acid receptor; CASPR2: contactin-associated protein-like 2; Lgi1: leucine-rich, glioma-inactivated 1; mGluR5: metabotrophic glutamate receptor 5. | |||
Other etiologies causing Anti NMDA encephalitis like features | |||
{| class="wikitable" | |||
|- | |||
! Differential diagnosis | |||
|- | |||
| Bacterial and viral infections of the brain | |||
| Herpes simplex virus type 1, Human herpes virus type 6, Enterovirus, Mycoplasma | |||
|- | |||
| Autoimmune-associated encephalitis | |||
| PANDAS, Sydenham chorea, Hashimoto encephalopathy, Rasmussen encephalitis, Encephalitis lethargica | |||
|- | |||
| Autoimmune synaptic receptor encephalitides | |||
| Neuronal antibodies to GABA, AMPA, and LGI1receptors | |||
|- | |||
| CNS vasculitis | |||
| Primary CNS angiitis, Secondary (due to chronic infection, inflammatory processes) | |||
|- | |||
|Demyelinating disorders | |||
|Acute disseminated encephalomyelitis, Neuromyelitis optica | |||
|- | |||
|Medication Overdose | |||
|Ketamine, Phencyclidine | |||
|} | |||
==References== | ==References== | ||
| Line 12: | Line 123: | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
<ref name="pmid29955485">{{cite journal| author=Nichols TA| title=Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community. | journal=Ment Health Clin | year= 2016 | volume= 6 | issue= 6 | pages= 297-303 | pmid=29955485 | doi=10.9740/mhc.2016.11.297 | pmc=6007532 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29955485 }} </ref> | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 07:27, 13 May 2023
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Differentiating Anti-NMDA receptor encephalitis from Other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;AE Dheeraj Makkar, M.D.[2]
Overview
In the differential diagnosis of anti-NMDA encephalitis, other autoimmune encephalitides with specific antibody associations should be considered, including those associated with antibodies against AMPA receptors, GABA-B receptors, LGI1, Caspr2, and MOG. Clinical and serological evaluations are crucial for accurate diagnosis and appropriate management.
Differentiating Anti-NMDA Receptor Encephalitis from other Diseases
| Antigen | NMDA receptor NR1 | Lgil | CASPR2 | AMPA receptor | GABA B receptor | Glycine receptor | MgluR5
|
|---|---|---|---|---|---|---|---|
| Age(median)/gender female : male | 0·6–85 (21) 4:1 | 30–80 (60) 1:2 | 46–77 (60) 1:4 | 38–87 (60) 9:1 | 24–75 (62) 1:1 | 5–69 (43) 6:5 | 46, 15 1:1 |
| Clinical syndrome | 1.Prodromal Syndrome
2. Psychiatric Syndrome, seizures, amnesia 3.Movement disorders catatonia, autonomic instability, |
Limbic encephalitis, tonic or facio-brachial dystonic seizures,
myoclonus
|
Morvan Syndrome, encephalitis, neuromyotonia | Limbic encephalitis, psychiatric syndrome | Limbic encephalitis | Encephalomyelitis with rigidity and myoclonus, hyperekplexia, stiff-person syndrome,
(retinopathy) |
Limbic encephalitis, myoclonus |
| MRI T2/FLAIR hyperintensities, medial temporal | 25% | 80% | 40% | 90% | 70% | 10% | 50% |
| CSF pleocytosis or Oligoclonal Bands | 95% | 40% | 25% | 90% | 90% | some oligoclonal bands | 2/2 only cases reported and present in them
|
ocb: oligoclonal bands; EEG: electroencephalograph; NMDA: N-methyl-D-aspartate; AMPA: α-amino-3-hydroxy-5-methyl-4-isoxazol-propionic acid; GABA: γ-amino-butyric acid receptor; CASPR2: contactin-associated protein-like 2; Lgi1: leucine-rich, glioma-inactivated 1; mGluR5: metabotrophic glutamate receptor 5.
Other etiologies causing Anti NMDA encephalitis like features
| Differential diagnosis
| |
|---|---|
| Bacterial and viral infections of the brain | Herpes simplex virus type 1, Human herpes virus type 6, Enterovirus, Mycoplasma
|
| Autoimmune-associated encephalitis | PANDAS, Sydenham chorea, Hashimoto encephalopathy, Rasmussen encephalitis, Encephalitis lethargica
|
| Autoimmune synaptic receptor encephalitides | Neuronal antibodies to GABA, AMPA, and LGI1receptors |
| CNS vasculitis | Primary CNS angiitis, Secondary (due to chronic infection, inflammatory processes) |
| Demyelinating disorders | Acute disseminated encephalomyelitis, Neuromyelitis optica |
| Medication Overdose | Ketamine, Phencyclidine |
References
- ↑ Nichols TA (2016). "Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community". Ment Health Clin. 6 (6): 297–303. doi:10.9740/mhc.2016.11.297. PMC 6007532. PMID 29955485.