Abnormal Brain MRI in Anti-NMDA Receptor Encephalitis
Laura Khatib, Julie Pique, Nicolás Lundahl Ciano-Petersen, Guillaume Criton, Cristina Birzu, Mélodie Aubart, Marie Bénaiteau, Géraldine Picard, Romain Marignier, Clarisse Carra‐Dallière, Xavier Ayrignac, Dimitri Psimaras, Pierre Labauge, Jérôme Honnorat, François Cotton, Bastien Joubert
Abstract
BACKGROUND AND OBJECTIVES: Abnormal brain MRI is associated with poor outcomes in anti-N-methyl-d-aspartate receptor encephalitis (NMDARE). We aimed to characterize the lesions on brain MRI in NMDARE and to assess the clinical and prognostic associations. METHODS: This retrospective cohort study included patients with NMDARE identified at the French Reference Center for Autoimmune Encephalitis, with at least a one-year follow-up, and with available brain MRI results. In case of brain extralimbic lesion, the image files were reviewed when available. Clinical data were collected from medical records. Multivariable logistic regression analysis was used to study the outcomes at 2-year follow-up; recovery was defined as modified Rankin Scale score ≤1. RESULTS: = 0.002; extensive lesions [n = 4] not included in the analysis). DISCUSSION: Brain MRI lesions in NMDARE include limbic hyperintensities and 3 patterns of extralimbic lesions, which are associated with nontypical NMDARE symptoms. Moreover, MS-like and extensive lesions, but not fluffy nor hippocampal lesions, are associated with overlapping demyelinating syndromes and poor clinical outcomes at 2 years. These findings can have practical implications on the monitoring of patients with NMDARE.