Diagnostic criteria for definite autoimmune limbic encephalitis

All four of the following criteria must be met:*

Subacute onset (rapid progression of <3 months) of working memory deficits (short-term memory loss), seizures, or psychiatric symptoms suggesting involvement of the limbic system
Bilateral brain abnormalities on T2-weighted fluid-attenuated inversion recovery MRI highly restricted to the medial temporal lobes^¶
At least one of the following:
- CSF pleocytosis (>5 white blood cells per mm³)
- EEG with epileptic or slow-wave activity involving the temporal lobes
Reasonable exclusion of alternative causes

MRI: magnetic resonance imaging; CSF: cerebrospinal fluid; EEG: electroencephalogram.

* If one of the first three criteria is not met, a diagnosis of definite limbic encephalitis can be made only with the detection of antibodies against cell-surface, synaptic, or onconeural proteins.

¶ 18-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to fulfill this criterion and may be more sensitive than MRI for detecting medial temporal lobe abnormalities.

Reproduced from: Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15:391. Table used with the permission of Elsevier Inc. All rights reserved.

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Diagnostic criteria for definite autoimmune limbic encephalitis