Abstract
Suspected Autoimmune Encephalitis in Hospitalized Adults: Diagnostic Yield and Predictors (P9-1.007)
Neurology, Vol.106(11_Supplement_1)
06/09/2026
DOI: 10.1212/WNL.0000000000215819
Abstract
Objective
To compare clinical and paraclinical features between hospitalized adults with expert-confirmed autoimmune encephalitis (AE) and those with suspected AE, but alternative final diagnoses, to identify predictors of AE.
Background
AE commonly presents with subacute neuropsychiatric symptoms, but remains challenging to diagnose. Neural autoantibodies can support the diagnosis, yet their importance depends on clinical context and they may require expert interpretation.
Design/Methods
We conducted a retrospective cohort study at Mass General Brigham, including consecutive adult inpatients for whom a serum autoimmune encephalopathy panel was ordered, either directly or on recommendation by neurology (November 2020–March 2022). Expert reviewers adjudicated final diagnoses. Among patients with any positive autoantibody result, positive predictive values (PPVs) for serum and CSF neural autoantibody panels were estimated for expert-confirmed AE. Group comparisons between AE and non-AE were performed, and predictors of AE were assessed using Firth’s penalized logistic regression.
Results
Among 269 patients included in the study, 20 (7.4%) had expert-confirmed AE and 249 had alternative final diagnoses. Compared with non-AE, AE cases more often had subacute cognitive decline (85% vs 48.6%, p<0.01), new onset seizure (55% vs 12.4%, p<0.01), malignancy within 5 years (40% vs 20.5%, p=0.05), inflammatory CSF (61.1% vs 32.1%, p=0.02), and an abnormal brain MRI (30% vs 5.6%, p<0.01). Among seropositive patients, the PPV for expert-confirmed AE was 10.3% for serum and 80% for CSF. In multivariable models, cognitive decline, seizures, malignancy, inflammatory CSF, and CSF autoantibody positivity independently predicted AE, whereas abnormal brain MRI and serum autoantibody positivity did not.
Conclusions
In hospitalized adults evaluated for suspected AE, expert-confirmed AE was uncommon, yet exhibited a coherent clinical/paraclinical profile. Subacute cognitive decline, new onset seizures, malignancy within 5 years, and inflammatory CSF support an AE diagnosis. Serum autoantibody results merit cautious interpretation; CSF autoantibody testing should be pursued in clinically suspicious cases.
Details
- Title: Subtitle
- Suspected Autoimmune Encephalitis in Hospitalized Adults: Diagnostic Yield and Predictors (P9-1.007)
- Creators
- Yoji Hoshina - Massachusetts General HospitalGiovanna ManzanoJoao Vitor Mahler - Massachusetts General HospitalSamuel Steuart - Massachusetts General HospitalBruna Leles Vieira de Souza - Massachusetts General HospitalPrashanth Rajarajan - Brigham and Women's HospitalRachel Rodin - Massachusetts General HospitalLeigh Rettenmaier - University of IowaCaleb McEntireAhmad Mashlah - Mass General BrighamPhilippe-Antoine Bilodeau - Massachusetts General HospitalAhya Ali - Westchester Medical CenterLeah Wibecan - Massachusetts General HospitalWesley Kerr - University of PittsburghJenny Linnoila - Urology Associates
- Resource Type
- Abstract
- Publication Details
- Neurology, Vol.106(11_Supplement_1)
- DOI
- 10.1212/WNL.0000000000215819
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Language
- English
- Date published
- 06/09/2026
- Academic Unit
- Ophthalmology and Visual Sciences
- Record Identifier
- 9985180878002771
Metrics
1 Record Views