We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Diagnosing Encephalitis, Not Otherwise Specified—Reply

Jeffrey M. Gelfand, MD, MAS1; Tarik Tihan, MD, PhD1; Bruce A. Cree, MD, PhD, MAS1,2
[+] Author Affiliations
1Department of Neurology, University of California, San Francisco
2Multiple Sclerosis Center, University of California, San Francisco
JAMA Neurol. 2015;72(6):726-727. doi:10.1001/jamaneurol.2015.0548.
Text Size: A A A
Published online


In Reply We agree with Wang and colleagues that clinical-pathological correlation is important in diagnosing the cause of encephalitis. It is possible that with contemporary technology more of these cases might have been confirmed as autoimmune or paraneoplastic based on advances in cerebrospinal fluid (CSF) or serum detection of antineuronal antibodies (banked CSF or serum was not available). Unbiased sequencing techniques pioneered at our institution using CSF and biopsy material are also beginning to provide significant and actionable findings.1 However, even today, there are many cases of encephalitis wherein the final diagnosis remains elusive despite extensive commercial- and research-grade testing for infectious, paraneoplastic, and autoimmune causes. There are also still cases of encephalitis, not otherwise specified (ENOS) that become apparent on brain biopsy when the preoperative diagnosis was not necessarily encephalitis. Completion of the pathology report and assessment of pathological findings are hardly ever performed without clinical and radiological correlation, and it is the rule rather than the exception that in these enigmatic cases, there is extensive discussion between the pathologist and clinical team to better understand the findings. Our results indicate that when the initial pathological diagnosis is ENOS, re-review of the pathological material, clinical reevaluation, and focused laboratory testing can have added diagnostic value.2


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





June 1, 2015
Zhi-li Wang, MD; Eric Lancaster, MD, PhD; Li Yang, MD, PhD
1Department of Neurology, The Second Xiangya Hospital, Central South University, Hunan, China
2Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
JAMA Neurol. 2015;72(6):725. doi:10.1001/jamaneurol.2015.0542.
June 1, 2015
Yingjie Zou, MD; Harrison Xiao Bai, MD; Yongguang Tao, PhD
1Cancer Research Institute of Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China
2Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia
JAMA Neurol. 2015;72(6):725-726. doi:10.1001/jamaneurol.2015.0545.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...