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Acute limbic encephalitis: a new entity?

Yoko Mochizuki1, Toshio Mizutani, Eiji Isozaki

  • 1Department of Pathology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183 0042, Japan. mochi@ica.nihon-u.ne.jp

Neuroscience Letters
|December 21, 2005
PubMed
Summary

Non-herpetic acute limbic encephalitis, often mimicking herpes simplex virus (HSV) encephalitis, is increasingly reported. This autopsy case reveals neuropathological findings distinct from HSV, aiding in understanding this condition.

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Area of Science:

  • Neurology
  • Pathology
  • Immunology

Background:

  • Clinical presentations resembling herpes simplex virus (HSV) encephalitis are frequently observed in Japan.
  • These cases, often termed "non-herpetic acute limbic encephalitis," lack definitive HSV confirmation.
  • Limited autopsy data exists due to the generally favorable prognosis of this condition.

Observation:

  • A 59-year-old woman presented with fever, altered consciousness, and intractable seizures.
  • Brain MRI showed abnormalities in the medial temporal lobes and putamen.
  • Serum and cerebrospinal fluid analysis revealed autoantibodies against NMDA glutamate receptors (GluR).

Findings:

  • Autopsy revealed neuronal loss, neuronophagia, and perivascular lymphocytic infiltration in the hippocampus and amygdala.

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  • No hemorrhagic necrosis was observed in the brain.
  • Immunohistochemical analysis excluded herpes simplex virus types 1 and 2, and human herpes virus-6.

    • Implications:

    • This autopsy case provides crucial neuropathological insights into non-herpetic acute limbic encephalitis.
    • The findings highlight autoimmune mechanisms, specifically anti-GluR antibodies, in this encephalitis subtype.
    • Understanding the pathology is vital for accurate diagnosis and potential therapeutic strategies.