Glioma misdiagnosed as autoimmune encephalitis in early stage: An analysis of 11 cases

Objective To understand the difference in clinical characteristics between glioma in the early stage and autoimmune encephalitis(AE), and provide basis for differential diagnosis. Methods In the study, 11 cases with glioma who misdiagnosed as AE in the early stage and 13 cases with con firmed AE from 2011 to 2016 in our hospital were enrolled.Their demographic data, clinical manifestation, lesion location, cerebrospinal fluid (CSF) analysis results, imaging features and treatment were reviewed and compared. Results There was no signi ficant difference between the two groups in age, gender, clinical symptoms and cerebrospinal fiuid analysis results, and no difference in lesion location, and features of enhancement on MRI.Magnetic resonance spectroscopy (MRS)analysis showed decreased NAA peak and increased Cho peak were more common in glioma compared with AE, and the Cho/NAA and Cho/Cr ratios of glioma were signi ficantly higher than those of AE (P＜ 0.01, respectively).Immunosuppressive therapy was not effective for patients with glioma, but effevtive in patients with AE. Conclusion In the early diagnosis of AE, especially when the antibody screening results are absence or negative, we can't rule out the possibility of glioma only by multiple lesions or no enhancement on MRI.MRS is valuable in early differentiation between glioma and AE.For patients who can not be definitively diagnosed as AE, MRS is recommended for differential diagnosis with glioma.When immunotherapy is not effective, we should consider the possibility of glioma.