Acceso usuarios
Paula Catalina Robles Monroy, Victoria Martínez Ángeles, Jesús Ramírez-Bermúdez, Arturo Violante Villanueva, Lilia Salas Alvarado, Xiomara García, Juan Carlos López Hernández
Introducción:
La encefalitis autoinmune representa una enfermedad neuropsiquiátrica grave que requiere un diagnóstico temprano. Este trabajo describe la frecuencia, características clínicas y paraclínicas en pacientes con encefalitis autoinmune posible (EAP) atendidos en un servicio de urgencias neurológicas, así como factores asociados a pobre pronóstico funcional al egreso.
Material y Métodos:
Estudio observacional tipo cohorte ambispectiva de pacientes con diagnóstico de EAP atendidos en un servicio de urgencias neurológicas en 2022. Se evaluaron características clínicas, paraclínicas, y desenlace funcional al egreso hospitalario a través de la escala de Rankin modificada (mRS): ≤2 puntos fue considerado como buen pronóstico). En el análisis estadístico utilizamos prueba de chi cuadrada, exacta de Fisher, T de Student y U de Mann-Whitney.
Resultados:
De 9046 pacientes, 31 (0.3%) cumplieron criterios de EAP. La edad promedio fue 28.4 ± 12.1 años, y el 51.6% fueron mujeres. Se observaron alteraciones cognitivas (90.3%), psicosis (74.2%), movimientos anormales (71%), catatonia (67.7%), crisis/estado epiléptico (64.5%, 19.4%) y disautonomías (58.1%). El 58.1% presento buen pronóstico funcional al egreso. Los factores asociados con mal pronóstico fueron: edad (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), estado epiléptico (0% vs. 46.2%, p = 0.002) y cefalea (61.1% vs. 15.4%, p = 0.025).
Conclusiones:
La EAP representa un diagnóstico poco frecuente en un centro de urgencias neurológicas; edad, estado epiléptico y cefalea fueron asociados a pobre pronostico funcional al egreso.
Autoimmune encephalitis (AE) represents a severe neuropsychiatric disorder that requires early diagnosis. This study describes the frequency, clinical characteristics, and paraclinical findings in patients with possible autoimmune encephalitis treated in a neurological emergency department, as well as factors associated with poor functional prognosis at discharge.
Material and Methods:
This was an observational ambispective cohort study including patients diagnosed with AE who were treated in a neurological emergency department in 2022. Demographic, clinical, and paraclinical characteristics were evaluated, along with functional outcomes using the modified Rankin scale (mRS); ≤2 points, was considered as good prognosis. In the statistical analysis we used the chi-squared test, Fisher’s exact test, Student’s T-test, and Mann-Whitney U test.
Results:
Out of 9046 patients, 31 (0.3%) met the criteria for probable autoimmune encephalitis (PAE). The average age was 28.4 ± 12.1 years and 51.6% were female. Cognitive alterations (90.3%), psychosis (74.2%), abnormal movements (71%), catatonia (67.7%), seizures/status epilepticus (64.5%, 19.4%), and dysautonomia (58.1%) were observed; 58.1% had a good functional prognosis. Factors associated with poor prognosis included older age (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), status epilepticus (0% vs. 46.2%, p = 0.002), and lower frequency of headache (61.1% vs. 15.4%, p = 0.025).
Conclusions:
AE represents a rare diagnosis even in a neurological emergency center; older age, status epilepticus and absence of headache were associated with poor functional prognosis at discharge.
