An Interesting Paraneoplastic Neurological Manifestation-Case Report

Abstract

Paraneoplastic limbic encephalitis is an
autoimmune disorder, frequently associated
with bronchial carcinoma. It is a
manifestation of encephalomyelitis,
which includes involvement of other regions
like pyriform cortex, orbital surface
of the temporal lobe, cerebellum and
brain stem. 45 yr old male was admitted
with complaints of memory disturbance
of 2 months with worsening over past 1
month. He also developed neuropsychiatric
symptoms such as talking to self,
auditory hallucinations,lack of sleep and
aggressive behaviour for the past 15
days .He did not have meningeal signs
or focal neurological deficit .He was
treated for carcinoma lung by full course
of chemotherapy one and half years
back. We proceeded with CSF examination
and MR imaging with contrast. Both
serum and CSF samples were sent for
analysis of paraneoplastic antibody profiles
.CSF analysis was negative for malignant
cells,HSV PCR but with presence
of moderate pleocytosis. Neuroimaging
revealed T2 and FLAIR hyperintensities in
bilateral hippocampal regions,not showing
much contrast enhancement. Paraneoplastic
antibody profile also were negative .With
background history of carcinoma lung, we
strongly thought of possibility of paraneoplastic
limbic encephalitis .We also ruled
out other possibilities like CNS infection
especially herpes simplex encephalitis and
metastases. Eventhough available antibody
profiles were negative, diagnosis of
paraneoplastic limbic encephalitis is
strongly supported by the classical clinical
feature , neuroimaging and good response
to steroid therapy. This case is presented
for its typical clinical and imaging features,
and the need to think of the possibility, as
this responds well to treatment of primary
tumor as well as immunomodulatory therapy.