Autoimmune encephalitis misdiagnosis and mimics

Alessandro Dinoto; Pietro Zara; Sara Mariotto; Sergio Ferrari; Eoin P Flanagan; Adrian Budhram; Daniela Orellana; Davide Turilli; Paolo Solla; Gregory S Day; Elia Sechi; A Sebastian Lopez-Chiriboga

doi:10.1016/j.jneuroim.2023.578071

Autoimmune encephalitis misdiagnosis and mimics

J Neuroimmunol. 2023 May 15:378:578071. doi: 10.1016/j.jneuroim.2023.578071. Epub 2023 Mar 16.

Authors

Affiliations

¹ Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Verona, Italy.
² Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
³ Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Neuroimmunology Laboratory, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada.
⁵ Department of Neurology, Mayo Clinic College of Medicine, Jacksonville, FL, USA.
⁶ Department of Neurology, Mayo Clinic College of Medicine, Jacksonville, FL, USA. Electronic address: lopezchiriboga.alfonso@mayo.edu.

PMID: 36989703
DOI: 10.1016/j.jneuroim.2023.578071

Abstract

The diagnosis of autoimmune encephalitis (AE) requires reasonable exclusion of other conditions. The aim of this study is to characterize mimickers and misdiagnoses of AE, thus we performed an independent PubMed search for mimickers of AEs or patients with alternative neurological disorders misdiagnosed as AE. Fifty-eight studies with 66 patients were included. Neoplastic (n = 17), infectious (n = 15), genetic (n = 13), neurodegenerative (n = 8), and other neurological (n = 8) or systemic autoimmune (n = 5) disorders were misdiagnosed as AE. The lack of fulfillment of diagnostic criteria for AE, atypical neuroimaging findings, non-inflammatory CSF findings, non-specific autoantibody specificities and partial response to immunotherapy were major confounding factors.

Keywords: Autoimmune encephalitis; Differential diagnosis; Mimickers; Misdiagnosis.

Publication types

Review

MeSH terms

Autoimmune Diseases of the Nervous System* / diagnosis
Diagnostic Errors
Encephalitis* / diagnostic imaging
Hashimoto Disease* / diagnosis
Humans

Supplementary concepts

Hashimoto's encephalitis