Comprehensive Review on the Neuro-ophthalmic Manifestations of Autoimmune Encephalitis Syndromes

Autoimmune encephalitides (AE) comprise a heterogeneous group of immune-mediated disorders characterized by inflammation of the central nervous system, frequently associated with antibodies targeting neuronal cell surface or intraneuronal proteins. Clinically, they manifest a wide range of neurological, psychiatric, and visual symptoms, many of which may be relatively specific to the underlying antibody subtype. The visual system is commonly affected, with disturbances involving either the afferent or efferent pathways. Efferent manifestations typically arise from brainstem or cerebellar involvement. Patients may present with ophthalmoparesis, resulting from cranial nerve dysfunction or abnormal ocular motor findings. These findings include various patterns of nystagmus, impaired smooth pursuit, dysmetric saccades, and other ocular motor abnormalities that reflect disruption of central gaze control mechanisms, which the patient may perceive as diplopia or oscillopsia. Afferent manifestations may include inflammatory processes such as optic neuritis or uveitis, leading to visual loss. In addition, papilledema secondary to intracranial hypertension can be observed in some cases. Cortical involvement can present as complex visual phenomena such as hallucinations, illusions, and higher-order perceptual deficits. These may include prosopagnosia, palinopsia, and simultanagnosia, indicating dysfunction in specialized visual processing areas. Recognizing the spectrum of visual disturbances in AE is clinically relevant, as it may guide early diagnosis, antibody testing, and targeted immunotherapy, ultimately improving patient outcomes.