A Comprehensive Case-Based Investigation on the Diagnostic Challenges and Therapeutic Management of Atypical Autoimmune Encephalitis Presenting with Rapid Cognitive Decline in Middle-Aged Adults
Keywords:
Autoimmune encephalitis, Cognitive decline, Immunotherapy, Case study, Differential diagnosis, Neuroinflammation, Middle-aged adultsAbstract
Purpose: This paper explores the clinical complexity, diagnostic ambiguity, and therapeutic uncertainties in the management of atypical autoimmune encephalitis (AE) in middle-aged adults presenting primarily with rapidly progressive cognitive decline. The study aims to inform clinical decision-making by dissecting uncommon presentations through in-depth case analysis.
Design: A case-based qualitative study design was employed, analyzing five middle-aged patients diagnosed with atypical AE. Each case was examined for presenting symptoms, diagnostic workup, therapeutic regimen, and outcome. Diagnostic modalities included MRI, CSF analysis, autoantibody panels, and neuropsychological assessments.
Findings: All patients displayed non-specific cognitive symptoms at onset, leading to initial misdiagnoses. Diagnosis was achieved only after exclusion of infectious and neurodegenerative etiologies, with therapeutic response to immunotherapy confirming AE. Delays in diagnosis correlated with poorer cognitive outcomes, highlighting the need for clinical suspicion in rapidly evolving cognitive impairment.
Practical implications: Clinicians must consider AE in differential diagnosis when encountering atypical dementia-like presentations in otherwise healthy adults. Early immunotherapy improves prognosis, stressing the urgency of expedited immunologic and neuroimaging workup.
Originality: This study provides original insights into underreported clinical phenotypes of AE, emphasizing real-world diagnostic dilemmas and therapeutic responses that challenge conventional AE paradigms.
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