Abstracts

Rationale: To assess clinical presentation, current management practice, and outcomes in patients with encephalitis.Methods: We retrospectively analyzed all patients treated for encephalitis between 2008 and 2011 at Columbia University Medical Center. The clinical presentation, diagnostic testing, treatment, final diagnosis, and outcome at time of discharge were stratified by confirmed or presumed etiology and compared between patients who presented in refractory status epilepticus (SE), who had nonrefractory or self-limited seizures or SE, and who had no seizures. Results: A total of 114 patients fulfilled our criteria of presumed autoimmune or viral encephalitis at time of presentation. Of these 19 were proven autoimmune or paraneoplastic, while another 10 were presumed autoimmune because of history and/or presence of other autoimmune disease. 8 were proven viral encephalitides, with another 38 cases that were idiopathic or presumed viral. The remaining 39 patients had other infectious etiologies, toxic-metabolic encephalopathy, neurodegenerative disease (largely CJD), or neoplasm. Of those with proven autoimmune encephalitis the median age was 41 and 79% were women. Of those with proven viral encephalitis the median age was 58 and 38% were women. 3 of 19 patients with autoimmune encephalitis presented with or developed SE shortly after presentation, compared with 2 of 8 with viral encephalitis. Those with viral encephalitis were significantly more likely than those with autoimmune encephalitis to present with fever (p < 0.01), and more likely to have a gastrointestinal illness within the week prior to presentation (p < 0.01). Both the autoimmune and the viral encephalitis patient groups were equally likely to present with SE (16% and 25% respectively). However, of the idiopathic group (n=48), 40% were in SE. Of the patients with proven autoimmune encephalitis 16/19 received immunotherapy during hospitalization and 50% of those received that therapy within 6 days of presentation. Of the patients with idiopathic encephalitis, only 13/48 (27%) received immunotherapy as part of their hospital course. SE was significantly associated with poor outcome defined as modified Rankin score of 4 or higher on discharge (p < 0.01), hospital stay >