Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We pre...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2013/608643 |
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| author | Ioannis Markakis Athanasios Papathanasiou Ermioni Papageorgiou Kostantinos Siarkos Georgios Gkekas |
| author_facet | Ioannis Markakis Athanasios Papathanasiou Ermioni Papageorgiou Kostantinos Siarkos Georgios Gkekas |
| author_sort | Ioannis Markakis |
| collection | DOAJ |
| description | Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance. |
| format | Article |
| id | doaj-art-e0893326ee944e8c8800bba9ba0f5aa0 |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-e0893326ee944e8c8800bba9ba0f5aa02025-02-03T06:48:29ZengWileyCase Reports in Neurological Medicine2090-66682090-66762013-01-01201310.1155/2013/608643608643Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic EncephalitisIoannis Markakis0Athanasios Papathanasiou1Ermioni Papageorgiou2Kostantinos Siarkos3Georgios Gkekas4Department of Neurology, “St. Panteleimon” General State Hospital of Piraeus, 18454 Nikaia, GreeceDepartment of Neurology, Essex Centre for Neurological Sciences, Queen’s Hospital, Romford, Essex RM7 0AG, UKDepartment of Neurology, “St. Panteleimon” General State Hospital of Piraeus, 18454 Nikaia, GreeceDepartment of Neurology, “St. Panteleimon” General State Hospital of Piraeus, 18454 Nikaia, GreeceDepartment of Neurology, “St. Panteleimon” General State Hospital of Piraeus, 18454 Nikaia, GreeceIntroduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance.http://dx.doi.org/10.1155/2013/608643 |
| spellingShingle | Ioannis Markakis Athanasios Papathanasiou Ermioni Papageorgiou Kostantinos Siarkos Georgios Gkekas Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis Case Reports in Neurological Medicine |
| title | Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis |
| title_full | Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis |
| title_fullStr | Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis |
| title_full_unstemmed | Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis |
| title_short | Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis |
| title_sort | paraneoplastic limbic encephalitis resembling acute herpetic encephalitis |
| url | http://dx.doi.org/10.1155/2013/608643 |
| work_keys_str_mv | AT ioannismarkakis paraneoplasticlimbicencephalitisresemblingacuteherpeticencephalitis AT athanasiospapathanasiou paraneoplasticlimbicencephalitisresemblingacuteherpeticencephalitis AT ermionipapageorgiou paraneoplasticlimbicencephalitisresemblingacuteherpeticencephalitis AT kostantinossiarkos paraneoplasticlimbicencephalitisresemblingacuteherpeticencephalitis AT georgiosgkekas paraneoplasticlimbicencephalitisresemblingacuteherpeticencephalitis |