Diagnostic and Therapeutic Approach to Autoimmune Neurologic Disorders

A. Sebastian López-Chiriboga, MD; Eoin P. Flanagan, MD


Semin Neurol. 2018;38(3):392-402. 

In This Article

Diagnostic Clues/When to Suspect an Immune-mediated Neurologic Disorder

Several clinical and paraclinical investigations can provide diagnostic clues suggestive of an immune-mediated etiology for a neurologic disorder:[4]

  • Acute or subacute course (usually <3 months).

  • Characteristic clinical syndrome (e.g., N-methyl-D-aspartic acid or N-methyl-D-aspartate receptor [NMDA-R] encephalitis; myasthenia gravis).

  • History of cancer, active malignancy, or risk factors for cancer (e.g., cigarette smoking).

  • Personal or family history of autoimmunity.

  • Seropositivity for organ or non–organ-specific autoantibodies (SSA, SSB).

  • Recent-onset cryptogenic epilepsy with frequent events or new-onset refractory status epilepticus (NORSE), with antiepileptic drug resistance.

  • Viral prodrome.

  • Inflammatory cerebrospinal fluid (CSF).

  • Magnetic resonance imaging (MRI) abnormalities suggestive of an autoimmune etiology (e.g., bilateral mesial temporal T2 hyperintensity).

  • Hypermetabolism or hypometabolism on functional imaging (e.g., positron emission tomography).