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Neuropsychiatric Disorders > Neuropsychiatry Of Encephalitis > Flashcards

Neuropsychiatry Of Encephalitis Flashcards

1
Q

What are the main groups of encephalitis by cause?

A

Infectious encephalitis
Immune-mediated encephalitis (post infectious and autoimmune)
Unknown

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2
Q

What cells produce antibodies?

A

B-lymphocytes

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3
Q

What are examples of immune mediated encephalitis?

A

Rasmussen encephalitis
Connective tissue diseases/vasculitis
ADEM
Basal ganglia encephalitis (lethargica)
Hashimoto encephalopathy
Antibody-associated encephalitis

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4
Q

When might encephalitis be T-cell mediated?

A

In paraneoplastic encephalitis

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5
Q

Which antibody associated encephalitides are less responsive to treatment?

A

Associated with cancer
Intracellular antigens

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6
Q

What are examples of bacterial causes of encephalitis?

A

Syphilis
Lyme
Tuberculosis

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7
Q

What are examples of viral causes of encephalitis?

A

Heroes
HIV
Measles
Influenza
Polio
Dengue
West Nile
JC Virus
CMV
Rabies

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8
Q

What are examples of protozoal causes of encephalitis?

A

Malaria
Toxoplasma
Sleeping sickness

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9
Q

What are examples of autoimmune causes of encephalitis?

A

Paraneoplastic
Non-paraneoplastic (NMDAR, LGI1, CASPR2, IgLON5)
Lupus
ADEM

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10
Q

Where does herpes encephalitis start?

A

Limbic system

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11
Q

What are the symptoms of acute HSV encephalitis?

A

Headache, fever, seizures
+
Agitation
Confusion
Psychosis
Mania
Delirium
Confabulation
Catatonia

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12
Q

What are the neuropsychiatric sequelae of HSV encephalitis (chronic)?

A

Cognitive impairment
Anterograde amnesia 25-75%
Retrograde amnesia
Executive dysfunction 40%
Disinhibition
Aggression
Kluver-Bucy

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13
Q

What are more likely causes of antibody encephalitis than targeting of VGKC?

A

Targeting of CASPR2
Targeting of LGI1
Both complex with VGKC

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14
Q

What is the characteristic progression of Anti NMDA receptor encephalitis?

A

Prodromal malaise/flu like symptoms
Psychiatric symptoms
Movement disorder
Seizures
Autonomic dysfunction

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15
Q

What are the psychiatric symptoms associated with Anti NMDAR encephalitis?

A

Agitation
Anxiety
Psychosis
Catatonia
Echolalia
Sleep disturbance

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16
Q

What are the investigations in Anti NMDAR encephalitis?

A

MRI - 33% abnormal
CSF - 80% abnormal
EEG - 80-90% abnormal (delta blush)
Malignancy found in 39%

17
Q

What is a typical investigation that is unhelpful in Anti NMDAR encephalitis?

A

Serum inflammatory markers

18
Q

What is likely to be seen in CSF with anti nmdar encephalitis?

A

Lymphophytic pleocytosis (over abundance of white blood cells) 75%

Oligoclonal bands (indicating immunoglobulins) 50%

19
Q

What are the mechanisms of Anti NMDAR encephalitis?

A

Antibodies target receptor causing internalisation
Resultant NMDAR hypofunction

20
Q

Which type of encephalitis are people with type 1 diabetes at increased risk for and why?

A

GAD65
They already have antibodies for it.

21
Q

What disorders is CASPR2 implicated in?

A

Autism and other neurodevelopmental disorders

22
Q

What are the intrinsic risk factors for LGI1 encephalitis?

A

HLA
Male gender

23
Q

When does LGI1 encephalitis typically present?

A

Early 60s

24
Q

What does LGI1 encephalitis typically get misdiagnosed as?

A

Alzheimer’s
Other dementias

25
Q

What does LGI1 encephalitis typically affect?qq

A

Medial temporal lobe
Particularly hippocampus (atrophy)

26
Q

What might you test for in a patient mimicking Anti NMDAR encephalitis but who has testing negative for NMDAR antibodies?

A

Neurexin

27
Q

What does IgLON5 encephalitis present as?

A

Chronic cognitive decline
Frank dementia

(IgLON5 typically seen on older people)

28
Q

What are the Graus criteria for anti NMDAR encephalitis?

A
  1. Less than three months onset of (4/6)
    - psychiatric abnormality or cognitive dysfunction
    -speech dysfunction
    -seizures
    -movement disorder
    -decreased consciousness
    -autonomic dysfunction or hypoventilation
  2. One of the below results
    - abnormal EEG
    -CSF with pleocytosis or oligoclonal bands
  3. Reasonable exclusion of other disorders
29
Q

What are the criteria for autoimmune encephalitis? (Barcelona)

A
  1. Less than 3 months onset of
    -working memory deficits
    -altered mental status
    -psychiatric symptoms
  2. At least one of
    -new focal CNS findings
    -seizures not explained by previous disorder
    -CSF pleocytosis
    -MRI suggestive of encephalitis
  3. Reasonable exclusion of other causes
30
Q

What is abnormal lymphocyte count?

A

More than 5

31
Q

At what point should it no longer be assumed that a patient has viral encephalitis?

A

After two negative viral PCRs (acyclovir should be given until then)

32
Q

How do the autoimmune psychosis diagnosis guidelines (Pollak et al) differ from Graus criteria?

A

Reduced emphasis on serum tests
More emphasis on CSF
Fewer factors needed to test for autoimmune encephalitis

33
Q

How is relapse likely to present in AE?

A

Isolated psychiatric or cognitive symptoms

34
Q

What impairments are people with Anti NMDAR encephalitis often left with?

A

Episodic memory
Processing speed
Executive function

35
Q

What impairments are people with Anti LGI1 encephalitis often left with?

A

Memory deficits (NTL atrophy)
Executive function
Attention
Semantic/phonemic fluency

36
Q

How long does recovery from AE typically take?

A

Months
May need to be in rehab

Neuropsychiatric Disorders (15 decks)

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