Abstract
IntroductionParaneoplastic limbic encephalitis remains a challenging clinical diagnosis with poor outcome if it is not recognized and treated early in the course of the disease.Case PresentationA 65-year-old Caucasian woman presented with generalized tonic-clonic seizures and increasing confusion shortly after a lung biopsy that led to the diagnosis of small-cell lung cancer. She had a complicated hospital course, and had recurrent respiratory distress due to aspiration pneumonia, and fluctuating mental status and seizures that were refractory to anti-epileptic drug treatment. Routine laboratory testing, magnetic resonance imaging of the brain, electroencephalogram, lumbar puncture, serum and cerebrospinal fluid tests for paraneoplastic antibodies, and chest computed tomography were performed on our patient. The diagnosis was paraneoplastic limbic encephalitis in the setting of small-cell lung cancer with positive N-type voltage-gated calcium channel antibody titer. Anti-epileptic drugs for seizures, chemotherapy for small-cell lung cancer, and intravenous immunoglobulin and steroids for paraneoplastic limbic encephalitis led to a resolution of her seizures and improved her mental status.ConclusionEarly recognition of paraneoplastic limbic encephalitis and prompt intervention with immune therapies at the onset of presentation will probably translate into more favorable neurological outcomes.
Highlights
Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poor outcome if it is not recognized and treated early in the course of the disease.Case Presentation: A 65-year-old Caucasian woman presented with generalized tonic-clonic seizures and increasing confusion shortly after a lung biopsy that led to the diagnosis of small-cell lung cancer
Early recognition of paraneoplastic limbic encephalitis and prompt intervention with immune therapies at the onset of presentation will probably translate into more favorable neurological outcomes
The current hypothesis for the pathogenesis of Paraneoplastic limbic encephalitis (PLE) implicates an autoimmune process involving antigens shared by tumor cells and neuronal cells in the mesial temporal and limbic structures, including cingulated gyrus, orbitofrontal cortex and mamillary bodies [2]
Summary
Paraneoplastic limbic encephalitis (PLE) was established as a distinct clinical and pathological entity by the British neuropathologist Corsellis and colleagues in 1968. Case Presentation A 65-year-old, right-handed Caucasian woman was transferred from a local hospital to our neurological intensive care unit (NICU) after a witnessed generalized tonic-clonic seizure. She had hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disorder, a history of heavy cigarette smoking and a longstanding but well-controlled bipolar disorder. Empiric treatment with intravenous acyclovir was initiated while HSV polymerase chain reaction (PCR) study from CSF was sent for analysis On her seventh day at the local hospital, she was observed having a generalized tonic-clonic seizure for which she received intravenous fosphenytoin. Computed tomography (CT) scan of the chest demonstrated mediastinal and hilar lymphadenopathy and pleural effusion in addition to a loculated right lower lobe (Figure 2E) Her lung cancer was not amenable to resection. She died eight months after the initial presentation due to progressive lung cancer
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