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Anti-N-methyl-D-aspartate receptor encephalitis: a prospective study focused on cerebrospinal fluid and clinical symptoms

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Abstract

Background and objective

To analyze the relationship between brain MRI, clinical symptoms, and cerebrospinal fluid (CSF) and to provide a reference for early diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.

Materials and Methods

A total of 62 patients with anti-NMDAR encephalitis in Zhengzhou, China (2016–2018) were observed and registered prospectively. First, we analyzed the characteristics of clinical symptoms. Second, according to the disease duration, patients were divided into two groups, and then we analyzed the CSF features. In addition, they were divided into two groups according to the brain MRI, and then the CSF features were analyzed. Finally, the characteristics of cerebrospinal fluid in patients with seizure as the initial symptom were analyzed.

Results

Seizure presents as the initial symptom in 14 patients (22.5%), including 11 males (78.57%). The proportion and concentration of CSF total protein abnormalities in the early stage group were significantly higher than those in the middle and late group (P < 0.05). The total protein concentration in the abnormal brain MRI group was significantly higher than that in the normal MRI group (P < 0.05).

Conclusion

Anti-NMDAR encephalitis should be suspected, when male patients complain of seizure as an initial symptom and have simultaneously had headaches or fever prior to onset. The sensitivity of anti-NMDAR antibody is higher in CSF than in serum. Total CSF protein is more prone to elevation in the middle and late stages of anti-NMDAR encephalitis. Brain MRI abnormalities with anti-NMDAR encephalitis are related to the total protein concentration of CSF, which may be related to the disease duration.

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Acknowledgments

The authors thank the patients for their collaboration.

Funding

This study was supported by the grant from the National Natural Science Foundation of China (81371438) and the National Natural Science Foundation of China (81771397).

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Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China

    Shouyi Wu, Yajun Lian, Yuan Chen, Yake Zheng, Chengze Wang, Qiaoman Zhang & Zhi Huang

  2. Department of Critical Care Medicine, The First Affiliated Hospital, Henan Traditional Chinese Medicine University, Zhengzhou City, Henan Province, People’s Republic of China

    Zhengrong Mao & Kai Pang

  3. Oncology Department, Zhengzhou Tumor Hospital, Henan University, Zhengzhou City, Henan Province, People’s Republic of China

    Huiqin Li

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  1. Shouyi Wu
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Correspondence to Yajun Lian or Zhengrong Mao.

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The Ethics Committee of the First Affiliated Hospital of Zhengzhou University approved this study (number: KY-2015-51).

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Wu, S., Li, H., Lian, Y. et al. Anti-N-methyl-D-aspartate receptor encephalitis: a prospective study focused on cerebrospinal fluid and clinical symptoms. Neurol Sci 41, 3255–3263 (2020). https://doi.org/10.1007/s10072-020-04451-0

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