Abstract
IntroductionParaneoplastic limbic encephalitis is a rare neurological syndrome and clinically characterized by cognitive dysfunction, memory impairment, seizures and psychiatric symptoms. Paraneoplastic limbic encephalitis is most frequently found in small-cell lung cancer, among various malignancies, and antineuronal antibodies are related to the autoimmune mechanism. We experienced a rare case of a patient with small-cell lung cancer with anti-voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis.Case presentationA 61-year-old Japanese man with a history of smoking cigarettes presented with seizure, confusion and personality change in acute onset. Brain magnetic resonance imaging showed high signal intensity on T2-weighted image in his right temporal lobe, suggestive of limbic encephalitis. A mediastinoscopy of the lymph node revealed small-cell lung carcinoma, and he was staged as having limited stage disease. Antibodies against P/Q-type and N-type voltage-gated calcium channel were positive and Hu antibody was negative. He was started on chemotherapy of carboplatin plus etoposide with concurrent thoracic radiotherapy. Neurological symptoms were gradually improved after systemic chemotherapy.ConclusionsWe should be alert to the potential of malignant neoplasms associated with paraneoplastic limbic encephalitis when we examine a patient with cancer with neurological disorders such as personality change, disorientation, unconsciousness and memory loss. A clinical marker such as voltage-gated calcium channel antibody may help our diagnosis in clinical practice.
Highlights
Paraneoplastic limbic encephalitis is a rare neurological syndrome and clinically characterized by cognitive dysfunction, memory impairment, seizures and psychiatric symptoms
We should be alert to the potential of malignant neoplasms associated with paraneoplastic limbic encephalitis when we examine a patient with cancer with neurological disorders such as personality change, disorientation, unconsciousness and memory loss
The anti-Hu antibody is the most common auto-antibody detected by Paraneoplastic limbic encephalitis (PLE), and anti-voltagegated calcium channel (VGCC) antibodies are found in patients with small-cell lung cancer (SCLC), usually with
Summary
When we examine a patient with cancer with neurological disorders such as personality change, disorientation, unconsciousness and memory loss, we should be alert to the potential of malignant neoplasms associated with PLE. Consent Written informed consent was obtained from the patient for the publication of this case report and its accompanying images. Abbreviations 18F-FDG: 2-[18F]-fluoro-2-deoxy-D-glucose; MRI: Magnetic resonance imaging; PET: Positron emission tomography; PLE: Paraneoplastic limbic encephalitis; PS: Performance status; SCLC: Small-cell lung cancer; VGCC: Voltage-gated calcium channel. Authors’ contributions KK and TO operated on the patient and were major contributors in making a conception, design, acquisition of data and drafting the manuscript or revising it critically for important intellectual content. HT and NH were contributors in making a conception, design and acquisition of data. MY made critical revisions to the manuscript. All authors read and approved the final manuscript
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