Abstract
IntroductionLimbic encephalitis is an autoimmune neurologic disorder, often of paraneoplastic origin, that seldom complicates prostatic tumors. The nonspecificity of symptoms makes the diagnosis sometimes difficult to establish. Prognosis is essentially determined by comorbidities and sensorineural and cognitive sequelae.Clinical caseA 66-year-old Caucasian patient known to have prostatic small-cell neuroendocrine adenocarcinoma under hormonal therapy developed complex partial epileptic seizures associated with rapidly aggravating severe memory impairment.The tripod of autoimmune limbic encephalitis diagnosis was based on the clinical aspect of brain’s functional deterioration, electroencephalography aspect, and γ-aminobutyric acid type B anti-receptor antibody positivity. Clinical, diagnostic, and therapeutic management as well as evolutionary risks were further analyzed.ConclusionLimbic encephalitis is an extremely rare presentation of neurologic paraneoplastic syndromes.A better knowledge of this entity would help better manage diagnostic and therapeutic difficulties and reduce the risk of possible sequelae.
Highlights
Limbic encephalitis is an autoimmune neurologic disorder, often of paraneoplastic origin, that seldom complicates prostatic tumors
Multiple antibodies responsible for limbic encephalitis were described and are mostly of paraneoplastic origin
Considering that GABAB anti-receptor antibodies limbic encephalitis is frequently associated with small-cell lung tumors, bronchoscopy with bronchial aspiration were performed, showing no evidence of malignancy
Summary
Limbic encephalitis is a rare autoimmune neurologic syndrome, frequently of paraneoplastic origin, caused by humoral and cellular response against intra- or extracellular specific neural antigens. Limbic encephalitis is often associated with small-cell lung cancer [1], and other cancers, testicular and ovarian neoplasms It is usually revealed by acute or subacute temporal epileptic seizures, anterograde memory impairments,. A few days later, he was hospitalized following the recurrence of the generalized epileptic crises His wife reported memory and concentration problems that appeared after the first epileptic episode, along with an escalating depressive syndrome. Brain MRI was performed 3 weeks after the first epileptic seizures showing left hippocampal and parahippocampal hypersignal in T2 and fluid-attenuated inversion recovery (FLAIR) sequences, with swelling appearance, without contrast enhancement, compatible with the initial diagnosis of limbic encephalitis (Fig. 2). Considering that GABAB anti-receptor antibodies limbic encephalitis is frequently associated with small-cell lung tumors, bronchoscopy with bronchial aspiration were performed, showing no evidence of malignancy. Considering the aggressive disease profile, it was decided to stop any further treatment and to confine the patient to palliative care
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