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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0045-1801860
Review Article

Immunomediated Encephalitis: New Diagnoses on the Neurology–Psychiatry Interface

Encefalite imunomediada: novos diagnósticos na interface neurologia–psiquiatria
Daniel Damiani 
1   Department of Neurology, School of Medicine, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
,
Aline Ribeiro de Bem
1   Department of Neurology, School of Medicine, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
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Abstract

Immune-mediated encephalitis is a real diagnostic challenge. Initially, patients present with subacute behavioral alterations, evolving over months, being attributed to purely psychiatric mechanisms, as well as neurological symptoms that often go unnoticed by professionals who are not neurologists. The etiologies behind these diseases are represented by paraneoplastic syndromes (including occult tumors) as well as viral infections, in both cases constituting true immunological triggers with exposure of antigens that will lead to a cross-immunological response directed at healthy structures of the nervous system. In the current review, we present the different clinical scenarios which differ based on antibodies against membrane receptors described so far, emphasizing the relevance of an early diagnosis for a smaller impact on prognosis.

Resumo

As encefalites imunomediadas constituem-se em um verdadeiro desafio diagnóstico. Inicialmente, os pacientes apresentam alterações comportamentais de caráter subagudo, com meses de evolução, sendo atribuídos a mecanismos puramente psiquiátricos, bem como sintomas neurológicos que passam muitas vezes despercebidos por profissionais não neurologistas. As etiologias por trás destas doenças são representadas por síndromes paraneoplásicas (incluindo tumores ocultos) bem como por infecções virais, em ambos os casos constituindo verdadeiros gatilhos imunológicos com exposição de antígenos que desencadeará uma resposta imunológica cruzada direcionada a estruturas saudáveis do sistema nervoso. Nesta revisão, apresentamos os diversos cenários clínicos diferenciados pelos anticorpos contra receptores de membrana descritos até o momento, enfatizando a relevância de um diagnóstico precoce para um menor impacto nos prognósticos.

Keywords

encephalitis - autoimmune encephalitis - antibody-mediated encephalitis - limbic encephalitis

Palavras-chave

encefalite - encefalites autoimune - encefalite mediada por anticorpos - encefalite límbica


Publication History

Received: 10 September 2023

Accepted: 23 October 2024

Article published online:
31 January 2025

© 2025. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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