Analysis of Relation Between Electroclinical Features and Cerebrospinal Fluid Antibody Titers in Patients With anti-NMDAR Encephalitis

2018 ◽  
Vol 50 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Ailiang Miao ◽  
Mingyang Du ◽  
Lingling Wang ◽  
Jianqing Ge ◽  
Hengdong Lu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Symptoms ◽  
Behavioral Changes ◽  
Female Patients ◽  
Nmdar Encephalitis ◽  
Initial Symptoms ◽  
Scale Scores ◽  
Antibody Titers ◽  
Male Patients ◽  
Eeg Recordings

Purpose. This study aimed to determine the relation between electroclinical features and cerebrospinal fluid (CSF) antibody titers in patients with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Method. Clinical symptoms and electroencephalography (EEG) at different stages were analyzed in 51 hospitalized patients with anti-NMDAR encephalitis. Results. Behavioral changes were the initial symptoms in 90.9% (20/22) of female patients with high (1:10 or 1:32) CSF antibody titers. A greater number of clinical symptoms were observed in the patients with high CSF antibody titers than in those with low (1:1 or 1:3.2) CSF antibody titers (mean 3.11 ± 1.06 vs 1.62 ± 0.65, P = .000). The number of clinical symptoms was greater in the female patients than in the male patients (mean 3.52 ± 0.98 vs 2.69 ± 1.09, P = .000). At the peak stage, worse background activity (BA) in EEG recordings was observed in patients with high CSF antibody titers than in those with low CSF antibody titers (Mann-Whitney U test, P = .001). The peak-stage BA in EEG was worse in female patients than in male patients (Mann-Whitney U test, P = .000). Modified Rankin scale scores were higher in patients with high CSF antibody titers than in those with low CSF antibody titers (mean 2.62 ± 1.42 vs 0.75 ± 0.97, P = .000). Brush patterns and constant chewing were observed primarily in female patients with high CSF antibody titers. Epileptic discharges were located predominately in the frontal regions and were noted to vary. Conclusion. The electroclinical features of patients with anti-NMDAR encephalitis were associated with gender and CSF antibody titers.

scholarly journals Clinical features and influencing prognostic factors in patients with anti-NMDAR encephalitis: a cohort follow-up study in Chinese patients

2019 ◽  
Author(s):  
Yingxin Wang ◽  
Ailiang Miao ◽  
Yongwei Shi ◽  
Jianqing Ge ◽  
Lingling Wang ◽  
...  
Keyword(s):  
Clinical Features ◽  
East China ◽  
Factors Associated ◽  
Female Patients ◽  
Nmdar Encephalitis ◽  
Consciousness Disturbance ◽  
Initial Symptoms ◽  
Antibody Titers ◽  
Male Patients ◽  
Poor Outcomes

Abstract Objectives The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed.Methods A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed.Results Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients ( P =0.000). Similarly, background activity (BA) with cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients ( P = 0.000). The Binary logistic regression and ROC curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR: 4.907, 95% CI: 1.653-14.562, P =0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P =0.014 ), EEG BA (OR: 3.743, 95% CI: 1.766-7.932, P =0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P =0.000), number of symptoms (OR: 2.911, 95% CI: 1.811-4.679, P =0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P =0.000) and CSF antibody titer (OR: 31.778, 95% CI: 8.891-113.57, P =0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P =0.000).Conclusions EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.

scholarly journals Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

2021 ◽  
Vol 10 (17) ◽  
pp. 3965
Author(s):  
Talia C. Oughourlian ◽  
Chencai Wang ◽  
Noriko Salamon ◽  
Langston T. Holly ◽  
Benjamin M. Ellingson
Keyword(s):  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Gray Matter Volume ◽  
Brain Regions ◽  
Cortical Volume ◽  
Female Patients ◽  
Asymptomatic Patients ◽  
Compensation Mechanisms ◽  
Male Patients ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.

scholarly journals Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Na Zhao ◽  
Xiao Hong Wang ◽  
Chuan Yi Kang ◽  
Yue Zheng ◽  
Li Ying Yang ◽  
...  
Keyword(s):  
Sex Differences ◽  
Cognitive Impairment ◽  
Clinical Symptoms ◽  
Verbal Learning ◽  
Chinese Patients ◽  
First Episode ◽  
Hamilton Depression Scale ◽  
Female Patients ◽  
Drug Naïve ◽  
Male Patients

Abstract Background Schizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia. Methods 93 FEDN patients (male/female = 45/48) and 160 controls (male/female = 74/86) were enrolled to compare the sex differences in cognitive functions measured by the MATRICS Consensus Cognitive Battery (MCCB). Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Scale (HAMD) were used to evaluate patients' clinical symptoms. We compared cognitive impairment with sociodemographic characteristics and measures of different genders, as well as group-by-sex interactions. Results Our results showed that male patients had significantly lower scores for symbol coding, digital sequence, and verbal learning than female patients, while the healthy controls showed similar sex differences. In female patients, multiple linear regression analysis confirmed that PANSS negative symptoms and general psychopathology scores, HAMD total score, and education level were independent contributors to MCCB total score. In male patients, only education was an independent contributor to MCCB total score. Conclusions These findings revealed significant sex differences in cognitive impairments and clinical symptoms in FEDN, which will be worthy of a follow-up study of schizophrenia in the future.

scholarly journals Encefalite autoimune anti recetor N-metil D-aspartato: relato de dois casos

2018 ◽  
Vol 28 (2) ◽  
pp. 29534
Author(s):  
Jorge André Soares Abreu Ferreira ◽  
Sara Cecilia Carneiro Peixoto ◽  
Inês Conceição Cancelo Carrilho ◽  
Vânia Sofia Vicente Martins
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Neuropsychiatric Symptoms ◽  
Brain Magnetic Resonance Imaging ◽  
Sudden Onset ◽  
Memory Deficit ◽  
Behavioral Changes ◽  
Resonance Imaging ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

AIMS: To report two cases with different presentations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a newly identified autoimmune disease characterized by consciousness changes, memory deficit, seizures, autonomic dysfunction and movement disorders.CASES DESCRIPTION: A six-year-old female, who presented with dystonic and choreoathetoid movements with refusal to walk. A 17-year-old male, presented with behavioral changes, retrograde amnesia and seizures. Electroencephalogram and brain magnetic resonance imaging did not show any significant findings. Anti-NMDAR antibodies were positive in cerebrospinal fluid in both cases and in serum in the first patient. Methylprednisolone, immunoglobulin and rituximab were given at different intervals. Both had a recurrence about six months later, with recovery at the end of one and a half year of the diagnosis.CONCLUSIONS: Anti-NMDAR encephalitis should be considered in patients with sudden onset of neuropsychiatric symptoms. Early diagnosis and treatment are major prognostic factors.

scholarly journals Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia

2021 ◽  
Author(s):  
Na Zhao ◽  
Xiao Hong Wang ◽  
Chuan Yi Kang ◽  
Yue Zheng ◽  
Li Ying Yang ◽  
...  
Keyword(s):  
Sex Differences ◽  
Cognitive Impairment ◽  
Clinical Symptoms ◽  
Verbal Learning ◽  
First Episode ◽  
Control Group ◽  
Hamilton Depression Scale ◽  
Female Patients ◽  
Drug Naïve ◽  
Male Patients

Abstract Background Schizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia. Methods 93 FEDN patients (male/female = 45/48) and 160 controls (male/female = 74/86) were enrolled to compare the sex differences in cognitive functions measure by the MATRICS Consensus Cognitive Battery (MCCB). Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Scale (HAMD) were used to evaluated patients' clinical symptoms. We compared cognitive impairment with sociodemographic characteristics and measures of different genders, as well as group-by-sex interactions. Results Our results showed that the MCCB total and index score in FEDN were lower than in the control group, except for category fluency and social cognition. Male patients had significantly lower symbol coding, digital sequence, and verbal learning scores than female patients, and the controls showed a similar sex difference. Interestingly, we also found six indexes and MCCB total score that showed diagnosis-by-sex interactions, belonging to the speed of processing, attention, working memory, and verbal learning. The MCCB total score showed correlations with PANSS total score and education for both genders. In female patients, education showed significant positive correlations with MCCB total and all ten index scores. Multiple linear regression analysis confirmed that negative symptoms and general psychopathology of PANSS, HAMD total score, and education were independent contributors to MCCB total score. In male patients, only education was an independent contributor to MCCB total score. Conclusions These findings revealed significant sex differences in cognitive impairments and clinical symptoms in FEDN. These results should be considered, which will be worthy of a follow-up study of schizophrenia in the future.

scholarly journals Atypical Presentation of Anti-NMDAR encephalitis in a Male Patient – an Unfortunate Mimic

2021 ◽  
Vol 8 (3) ◽  
pp. 01-03
Author(s):  
You Tan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Refractory Status Epilepticus ◽  
Behavioral Symptoms ◽  
Resonance Imaging ◽  
Leptomeningeal Enhancement ◽  
Fluid Analysis ◽  
Nmdar Encephalitis ◽  
Initial Symptoms

Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disorder with a predilection for females. Males present differently, with seizures rather than the better-recognized constellation of psychiatric and behavioral symptoms dominating the initial stages of the disease, providing a potential substrate for delayed recognition and treatment. Case Presentation An 18-year-old man presented with fever and “seizures. When examined, he was febrile but alert and coherent. His neurologic, respiratory, cardiovascular, and abdominal examinations were unremarkable. Diagnosed with infective meningoencephalitis, he was started on intravenous ceftriaxone and acyclovir concurrently with anti-epileptic medications. However, he deteriorated into refractory status epilepticus. Electroencephalograms showed left temporo-parietal seizures. Cerebrospinal fluid analysis revealed inflammatory features, but the virologic assays and bacterial cultures returned negative. Magnetic resonance imaging scans performed in the first and second week from symptom-onset demonstrated the interval development of widespread sulcal T2 hyperintensity, with florid and diffuse leptomeningeal enhancement. Anti-NMDAR antibodies were subsequently detected in his cerebrospinal fluid by indirect immunofluorescence. Diagnosed with anti-NMDAR encephalitis, he received plasmapheresis, methylprednisolone and immunoglobulin infusions. Conclusion Anti-NMDAR encephalitis should be considered in patients, especially males, who are treated for suspected infectious meningoencephalitis, but continue to deteriorate, even in the absence of prominent psychiatric or behavioral symptoms, considering how the initial symptoms differ between the genders. The interval development of diffuse and florid leptomeningeal enhancement on sequential magnetic resonance imaging scans of our patient has not been described in prior reports, and may be reflective of the underlying inflammatory processes.

scholarly journals Sex Differences in Clinical Characteristics and Risk Factors for Disease Severity of Hospitalized Patients with COVID-19 in Beijing

2020 ◽  
Author(s):  
Jingjing Wang ◽  
Yunjuan Su ◽  
Qi Wang ◽  
Ying Cao ◽  
Aibin Wang ◽  
...  
Keyword(s):  
Sex Differences ◽  
Disease Severity ◽  
Clinical Symptoms ◽  
Imaging Study ◽  
Hospitalized Patients ◽  
Laboratory Findings ◽  
Laboratory Test Results ◽  
Initial Symptoms ◽  
Male Patients ◽  
The Mean

Abstract Background: Recent studies reported that sex differences in patients with coronavirus disease-2019 (COVID-19). However the predictive value of sex differences in disease severity were less studied by previous scholars. Methods: All adults (≥18 years) diagnosed with COVID-19 and admitted to Beijing Ditan Hospital, Capital Medical University (admission date from January 13 to March 19, 2020) were included in samples. Data analyzed in this study included epidemiological, demographic, comorbidities, initial symptoms and signs, laboratory findings, imaging study, disease severity and in-hospital mortality. Results: A total of 185 inpatients were enrolled in the study, among whom 95 patients are males (51.4%). The mean age of all patients was 41 years. Based on the hospital record, the duration from symptoms initiation to hospital admission was longer for men than that for women. Moreover, the mean BMI of males was relatively higher compared to females (25.45vs22.29, p<.001). In addition, the proportion of male patients with CHD, NAFLD, smoking and drinking history was higher than females. During the hospital stay, compared to female patients, male patients were more prone to develop symptoms such as high fever, cough, and chill. Higher levels of AST, CK, CRP and FIB were also observed in male patients. Following this fact, more patients with abnormal CT activities, severe and critical symptoms were developed in male group than females. However, there was no difference in complications and outcome between two groups. By analyzing data comprehensively, we found out that age (analyzed in quartiles, OR: 1.087; 95% CI: 1.038–1.139; p <.001) and BMI (OR: 1.250; 95% CI: 1.046–1.493; p =.014) could be used to help predict disease severity. Conclusions: In this cohort of hospitalized patients in Beijing, male patients developed more clinical symptoms, obtained more abnormal laboratory test results, and showed higher rates in severity of COVID-19. Other than that, the severity of COVID-19 was positively correlated with age and BMI independently.

scholarly journals Clinical and biochemical manifestations of systemic lupus erythematosus at first diagnosis within Chinese patients

2019 ◽  
Author(s):  
changhao xie ◽  
li li zhang ◽  
yuan yuan wang ◽  
zhi jun li ◽  
lin jie chen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Age Of Onset ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Malar Rash ◽  
Female Patients ◽  
Initial Symptoms ◽  
Male Patients ◽  
First Diagnosis

Abstract Bankground: The objective of this paper was to describe the first symptoms associated with systemic lupus erythematosus (SLE), including clinical manifestations, laboratory findings, prognoses, differences between men and women at the time of first diagnosis of SLE. Methods : We enrolled 223 patients with initial diagnosis of SLE. Their initial symptoms, demographic, clinical and laboratory data，prognoses and causes of death were analyzed retrospectively. Clinical manifestations and laboratory profiles were compared between male and female patients. Results: Compared with female patients, male patients had an earlier age of onset, a higher incidence of neuropsychiatric involvements, a lower incidence of leukocytopenia , and a higher score of SLE Disease Activity Index (SLEDAI）at diagnosis. Fever and malar rash were most frequent presentations at onset of SLE. The most common clinical manifestation at first diagnosis was fever, followed by arthralgia, malar rash, Raynaud ’ s phenomenon, arthritis. The liver function abnormalities included increased ALT,AST,ALP and γ-GGT.ANA were found in 100% of patients, followed by anti-dsDNA(LIA) in 72.1%, anti-Ro60 in 67.8%, anti-Ro52 in 62.3%, anti-nucleosomes in 55.7%. Conclusions: We identified clinical and serological manifestations of Chinese SLE patients at first diagnosis. Male patients showed a distinctive manifestation including younger age of onset，a higher incidence of CNS manifestations, a higher score of SLEDAI compared to females.

scholarly journals Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Ovarian Teratoma Improved by Prompt Surgery

2021 ◽  
Vol 39 (4) ◽  
pp. 340-342
Author(s):  
Seok-Yeol Yang ◽  
Wooryang Byun ◽  
Sung-Pa Park ◽  
Jong-Geun Seo
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Outcome ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Clinical Manifestations ◽  
Early Surgery ◽  
Ovarian Teratoma ◽  
Aspartate Receptor ◽  
Early Removal ◽  
Nmdar Encephalitis

Anti-N-methyl-D aspartate receptor (NMDAR) encephalitis is often accompanied with ovarian teratomas. It has a variety of clinical manifestations including psychiatric symptoms, seizure, and motor dysfunctions. The diagnosis can be definite when clinical symptoms are present and anti-NMDAR antibodies in cerebrospinal fluid are detected. However, in patients with suspected anti-NMDAR encephalitis with teratomas, early surgery may help the clinical outcome even if the antibodies are initially negative. The authors report a patient whose clinical symptoms improved significantly after early removal of teratoma.

Sign in / Sign up

Export Citation Format

Share Document