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Seronegative Autoimmune Encephalitis — SCE Neurology MCQ

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HardCNS InfectionsSeronegative Autoimmune EncephalitisSCE Neurology

A woman has 8 weeks of new memory impairment, focal seizures and behavioural change. MRI shows bilateral mesial-temporal T2 hyperintensity and CSF has a lymphocytic pleocytosis. HSV/VZV PCR and bacterial studies are negative; serum and CSF neural-antibody panels are pending. What is the most appropriate next step?

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Correct answer: B — Begin first-line immunotherapy after infectious samples are collected and initial tests are negative

Antibody-negative autoimmune encephalitis is recognised. Once appropriate infectious investigations have been obtained and infection is reasonably excluded, do not delay first-line immunotherapy solely while neural-antibody results remain negative or pending.

Reference: Best-practice recommendations for diagnosis and acute management of autoimmune encephalitis: https://pubmed.ncbi.nlm.nih.gov/33649022/