Clinical manifestations in teratoma-associated anti-LGI1 encephalitis and anti-NMDAR encephalitis cases
The clinical features of this case of teratoma-associated anti-LGI1 encephalitis and the three cases of anti-NMDAR encephalitis with teratoma were summarized in Table 2.
There are many different points between the two subgroups: 1) age at onset of anti-LGI1 encephalitis with teratoma was older than that of anti-NMDAR encephalitis (average age 27.7); 2) our teratoma-associated anti-LGI1 encephalitis case presented with chronic anxiety as a prominent symptom at onset, compared to acute onset and no mood changes during the disease course in the anti-NMDAR encephalitis with teratoma; 3) the anti-LGI1 encephalitis case developed convulsive SE during disease course, but never had single generalized tonic-clonic seizure (GTCS), which was seen in 67% of anti-NMDAR encephalitis cases; 4) fever, headache and sleep disorder has been seen in anti-NMDAR encephalitis was absent in the anti-LGI1 encephalitis case; 5) the anti-LGI1 case presented hyponatremia, was not seen in any of the anti-NMDAR encephalitis cases; 6) normal CSF cell count presented in the anti-LGI1 encephalitis case was elevated in 67% of anti-NMDAR encephalitis; 7) typical hippocampal hyperintensity on T2/FLAIR MRI in anti-LGI encephalitis was seen in only 33% of anti-NMDAR encephalitis. Additionally, lesion on MRI without enhancement in anti-LGI1 encephalitis was characteristic compared to meningeal enhancement in 33% of anti-NMDAR encephalitis. 8) residual short-term memory impairment in the anti-LGI1 encephalitis was recovered fully in 67% of anti-NMDAR encephalitis.
Also several similarities they shared, including 1) cognitive impairment, as seen in 67% of the anti-NMDAR encephalitis; 2) behavioral disorders and sleep disorders, as seen in 100% of the anti-NMDAR encephalitis; 3) the anti-LGI1 case and two of three anti-NMDAR encephalitis patients were all transferred to ICU because of respiratory disorders; 4) diffused slow wave in EEG, as seen in 67% of the anti-NMDAR encephalitis.