Clinical manifestations in anti-LGI1 encephalitis cases with and without teratoma
The clinical features of this case of teratoma-associated anti-LGI1 encephalitis and of the nine other cases without teratoma are summarized in Table 2.
Our case with teratoma shared many clinical features with those subjects without teratoma (NT group), including 1) age at onset of 48, near the average of 47.3 years in the NT group; 2) hyponatremia, as seen in 78% of the NT group; 3) normal CSF cell count and protein, as seen in 78% of the NT group; 4) positive LGI1 antibody, as seen in blood and/or CSF of all subjects; 5) hippocampal hyperintensity on MRI, as seen in 89% of the NT group; 6) slow waves on EEG, as seen in 33% of the NT group; 7) cognitive impairment and sleep disorder, seen in 67% of the NT group; 8) residual cognitive impairment >1 year after admission, as seen in 67% of the NT group; and 9) only mild neurological disability during follow-up: the mRS score was 1 in the patient with teratoma, as compared to <=2 in 67% of the NT group.
However, there are also four key points in which the patient with teratoma significantly differed from those without. First, she presented with chronic anxiety as a prominent symptom; only one patient in the NT group had anxiety as a symptom, and this was acute anxiety beginning simultaneously with FBDS. Second, her anxiety was persistent, lasting for nine months from onset; the NT patient with acute anxiety had resolution of this feature by two months follow up. Third, the patient with teratoma developed convulsive SE during her course, but never had FBDS, as was seen in several of the NT group in both the acute stage of their disease and during follow up.