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A 49 year old man with a past history of inferior
pulmonary abscess and MI 5 months prior to admission.
One month before admission he had a syncopal episode
and one week before describes a picture of acute
psychosis. On admission he presents disorientated,
with fluctuating levels of consciousness, fever
and monoparesis of ESD. The lumbar puncture did
not show more than a slight increase in proteins
in CSF. In the MRI there were hyperintense lesions
scattered throughout the brain (Image 1). He developed
epilepsy refractory to conventional treatment,
with repeated focal convulsive crises and status
epilepticus and frequent hallucinatory crises
accompanied by very vivid sensorial perceptions
(uncinate crises).
In the autopsy a undifferentiated lung carcinoma
of the "oat cell" type was found. As
much in brain, as in the associated nervous tissue
to the intestine was intense infiltrated inflammatory
mononuclear, an interstitial one and to perivascular
with gliosis, neuronofagia and neuronal loss.
The anti-Hu antibodies were positive. The limbic
encephalitis is an inflammatory process of an
autoinmune nature triggered by the existence of
an underlying cancer, frequently lung ("oat
cell"), breast, seminoma, lymphoma, etc.
Clinically it is characterised by a presentation
consisting of acute or subacute course alterations
of conduct, memory and status epilepticus with
partial complex or temporal seizures, known as
uncinate crises with prominent hallucinations
and vegetative alterations.
Authors:
Juan I Pérez Calvo
José Luis Morales Rull
Tomás Castiella Muruzábal *
Servicio de Medicina Interna
* Servicio de Anatomía Patológica
Hospital Clínico Universitario “Lozano
Blesa”
Zaragoza-España
Translation: Kelly
Watt |
