Abstract
Background: The aim of the current study was to explore the characteristics of cerebrospinal fluid (CSF) cytology in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.
Methods: CSF was collected from patients with anti-NMDAR encephalitis at Peking Union Medical College Hospital and Henan Provincial People’s Hospital from 01 January 2015 to 31 December 2018. Cytological characteristics and other parameters of the CSF were analyzed.
Results: CSF cytological data were obtained from 164 patients with anti-NMDAR encephalitis. Visible signs of inflammation were identified in cytological analyses of 112 patients’ CSF, including 46 cases of mild inflammation, 58 of moderate inflammation, and 8 of severe inflammation. With regard to inflammation type, 89 cases were classified as lymphocytic inflammation, 22 as mixed inflammation with both lymphocytes and neutrophils, and 1 case was classified as mixed inflammation with lymphocytes, neutrophils, and eosinophils. Activated lymphocytes were detected in 51 patients, and plasma cells were detected in 16. Oligoclonal bands were detected in 111/164 patients, and 51 patients were positive for specific oligoclonal bands in CSF. The positivity rate was 45.9%. In non-pleocytosis subgroup based on routine CSF examination, mRS score was positively correlated with white cell count and degree of inflammation determined via CSF cytology (rho = 0.259, p = 0.047; rho = 0.264, p = 0.043, respectively), and patients with CSF inflammation detected by cytology were likely to have more serious disease severity (mRS>3) ( χ2 = 5.544, p = 0.019) in comparison to patients with negative cytological findings.
Conclusions: The superiority of evaluating cell morphology and the ability of detecting inflammatory state that has not been exhibited in routine examination render CSF cytology a candidate for identifying anti-NMDAR encephalitis and investigating its pathogenesis.
Lyme Disease and Associated NMDAR Encephalitis: A Case Report and Literature Review
