Abstract
IntroductionThe neurocognitive deficits associated with small cell lung cancer include metastasis to brain and paraneoplastic syndrome. The patients are also predisposed to herpes encephalitis due to immunosuppression and chemotherapy.Case presentationWe report a case of 72 year old female diagnosed with small cell lung cancer started with memory deficits, ataxia, vertigo, and hearing loss. The paraneoplastic work-up returned as anti-Hu antibody positive. The MRI brain showed area of edema and inflammation right medial temporal lobe as well as enhancement in the underlying meningi. Although PCR/HSV of CSF was negative, the patient was empirically treated with IV acyclovir and showed significant improvement and was discharged in good condition.ConclusionThe case highlights the importance of keeping broad minded approach in treating patients with serious malignant diseases. The case also call attention to the use of empiric therapy in possible life threatening diseases such as Herpes encephalitis
Highlights
The neurocognitive deficits associated with small cell lung cancer include metastasis to brain and paraneoplastic syndrome
We report a case of 72 year old female diagnosed with small cell lung cancer started with neurocognitive deficits over the few weeks
The patient was empirically treated for suspected herpes encephalitis on the basis of clinical and MRI findings with acyclovir and showed significant improvement
Summary
We report a case of 72 year old female diagnosed with small cell lung cancer started with neurocognitive deficits over the few weeks. In May 2008, 72 year old female was diagnosed of small cell lung cancer incidentally after she was hospitalized for anxiety and dizziness She was hyponatremic and series of tests which included a CT scan of the chest which showed right hilar lymphadenopathy and mediastinal lymphadenopathy (Figure 1). MRI of brain showed new area of edema and inflammation in the right medial temporal lobe as well as enhancement in the underlying meningi (Figure 2) She was admitted for to the hospital for empiric IV acyclovir therapy for possible herpes encephalitis. Anti-Hu antibodies are present in about 50% of patients with limbic encephalitis and lung cancer and is characterized by marked reduction in short term memory and sub acute confusion. PCR itself has a reported sensitivity of 98% and a specificity of 94% for the detection of HSV in the CSF [8]
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