Possible Autoimmune Encephalitis Criteria (Graus 2016)
Graus 2016 clinical criteria for possible autoimmune encephalitis, usable before antibody results. Neural antibody testing (serum and CSF) then defines the immunological subtype and a definite diagnosis.
Score interpretation
No subacute onset of the core symptoms, or none of the supporting findings (Graus 2016).
→ Prioritise infectious causes; IV aciclovir for HSV encephalitis pending PCR (adults: 10mg/kg TDS); CSF culture; MRI brain; neurology review; repeat LP if initial CSF normal. Children: use a children's formulary.
Subacute onset plus at least one supporting finding, but alternative causes are not yet reasonably excluded.
→ Continue IV aciclovir until HSV PCR negative; send neural antibody panel (serum + CSF); EEG; CT chest/abdomen/pelvis for paraneoplastic; consider empirical IVIG or IV methylprednisolone if antibodies pending and deteriorating
All three Graus criteria met: immunotherapy can be started without waiting for antibody results; a matching neural antibody makes the diagnosis definite.
→ First-line immunotherapy (adult doses): IV methylprednisolone 1g/day x5 + IVIG 2g/kg + plasmapheresis if NMDAR-Ab; ICU monitoring; anti-epileptic for seizures; oncology for paraneoplastic; rituximab or cyclophosphamide if first-line fails. Children: use a children's formulary.
Interpretation bands for the Autoimmune Encephalitis Criteria. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Azathioprine · Systemic Immunosuppressant — Eczema / Autoimmune Dermatoses
- Mycophenolate Mofetil · Systemic Immunosuppressant — Bullous Diseases / Autoimmune Dermatoses
- Normal immunoglobulin (IVIG / SCIG) · Pooled human immunoglobulin
- Japanese encephalitis vaccine · Vaccine
- Tick-borne encephalitis vaccine · Inactivated TBE vaccine
- Aciclovir (Paediatric) · Antiviral — HSV Encephalitis / Neonatal Herpes / VZV in Immunocompromised
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
