Rare paraneoplastic syndrome of prostatic cancer: limbic encephalitis: a case report

Abstract Introduction Limbic 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 case A 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. Conclusion Limbic 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.

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Limbic Encephalitis Associated with COVID-19

Encyclopedia ◽

10.3390/encyclopedia2010003 ◽

2021 ◽

Vol 2 (1) ◽

pp. 26-35

Author(s):

Natalia A. Shnayder ◽

Timur K. Sirbiladze ◽

Irina V. Demko ◽

Marina M. Petrova ◽

Regina F. Nasyrova

Keyword(s):

Memory Impairment ◽

Limbic Encephalitis ◽

Cognitive Disorders ◽

Epileptic Seizures ◽

Long Term Memory ◽

Short Term ◽

Magnetic Resonance Imaging Mri ◽

Electroencephalogram Eeg ◽

The Brain

Limbic encephalitis (LE) is an inflammatory disease of the brain, in which lesion is anatomically limited in structures of the limbic system. In some cases, LE can start with symptoms of limbic dysfunction with further involvement of other regions of the brain. Classic LE syndrome includes such symptoms as the development of personality disorders, depression, sleep disorders, epileptic seizures, hallucinations and cognitive disorders (short-term and long-term memory impairment). The information of clinical examination, electroencephalogram (EEG), magnetic resonance imaging (MRI) and cerebrospinal fluid studies (CSF) suggest the diagnosis of LE in most patients with Coronavirus Disease 2019 (COVID-19).

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Recurrent Anti-AMPA Receptor Limbic Encephalitis: A Case Report and Literature Review

Frontiers in Neurology ◽

10.3389/fneur.2021.735983 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuanyuan Fang ◽

Dengji Pan ◽

Hao Huang

Keyword(s):

Differential Diagnosis ◽

Ampa Receptor ◽

Magnetic Resonance Image ◽

Limbic Encephalitis ◽

Autoimmune Encephalitis ◽

Imaging Findings ◽

Rare Presentation ◽

Important Differential Diagnosis ◽

Autoimmune Limbic Encephalitis ◽

Multiple Relapses

Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor encephalitis is a relatively rare anti-neuronal surface antigen autoimmune encephalitis (LE). We described a case of a 47-year-old Chinese man having anti-AMPA receptor limbic encephalitis initially presented with cognitive decline, undetectable antibodies, and normal imaging findings in magnetic resonance image (MRI) and then developed into typical autoimmune limbic encephalitis a few months later with a course of multiple relapses. In addition, we found progressive brain atrophy in our case, which was a rare presentation of LE. This report also summarized the characteristics of nine reported cases of anti-AMPA receptor limbic encephalitis with relapse up to date. This case highlighted that autoimmune limbic encephalitis is an important differential diagnosis for patients with typical symptoms even when the MRI and antibodies are normal, and more attention should be paid to the relapse of anti-AMPA receptor encephalitis.

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Cognitive Impairments Preceding and Outlasting Autoimmune Limbic Encephalitis

Case Reports in Neurological Medicine ◽

10.1155/2016/7247235 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Robert Gross ◽

Jennifer Davis ◽

Julie Roth ◽

Henry Querfurth

Keyword(s):

Cognitive Deficits ◽

Memory Impairment ◽

Limbic Encephalitis ◽

Neuropsychological Testing ◽

Diagnostic Challenge ◽

Initial Manifestation ◽

Personality Changes ◽

Immune Therapies ◽

Autoimmune Limbic Encephalitis

Mild cognitive impairment (MCI) can be the initial manifestation of autoimmune limbic encephalitis (ALE), a disorder that at times presents a diagnostic challenge. In addition to memory impairment, clinical features that might suggest this disorder include personality changes, agitation, insomnia, alterations of consciousness, and seizures. Once recognized, ALE typically responds to treatment with immune therapies, but long-term cognitive deficits may remain. We report two cases of patients with MCI who were ultimately diagnosed with ALE with antibodies against the voltage gated potassium channel complex. Months after apparent resolution of their encephalitides, both underwent neuropsychological testing, which demonstrated persistent cognitive deficits, primarily in the domains of memory and executive function, for cases 1 and 2, respectively. A brief review of the literature is included.

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Efficacy of Tocilizumab in Limbic Encephalitis with Anti-CASPR2 Antibodies

Case Reports in Neurological Medicine ◽

10.1155/2020/5697670 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Maurizio Benucci ◽

Luciana Tramacere ◽

Maria Infantino ◽

Mariangela Manfredi ◽

Valentina Grossi ◽

...

Keyword(s):

Limbic Encephalitis ◽

Epileptic Seizures ◽

Emission Tomography ◽

High Dose ◽

Resonance Imaging ◽

Mood Changes ◽

Positron Emission ◽

Autoimmune Limbic Encephalitis ◽

Magnetic Resonance Imaging Mri ◽

Fluorodeoxyglucose Positron Emission

We report the case of a 64-year-old man who presented with subacute memory, balance impairment, behavioral and mood changes, and epileptic seizures. Magnetic resonance imaging (MRI) showed bilateral hippocampal abnormalities. Brain [18F]-FDG fluorodeoxyglucose positron emission tomography (PET) revealed hypometabolism in both the temporal lobe as well as in the left insular and parietal regions. The clinical and neuroradiological picture and the detection of anti-CASPR2 antibodies in serum oriented the diagnosis towards autoimmune limbic encephalitis. Intravenous high-dose steroid and immunoglobulin treatments were ineffective. We did not use rituximab for the presence of antibodies to HbcAg positivity. Tocilizumab given intravenously 8 mg/kg once a month for six months and then subcutaneously 162 mg every week for six months resulted in clinical and neuroradiological improvement. These data support the efficacy of tocilizumab in autoimmune limbic encephalitis associated with anti-CASPR2 antibodies, which has been sporadically reported in the literature.

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Anti-LGI1 Antibody Limbic Encephalitis Associated with Hepatocellular Carcinoma

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.4.3 ◽

2020 ◽

Vol 38 (4) ◽

pp. 272-275

Author(s):

Seokhong Choi ◽

Du Hwan Kim ◽

Hyun Joon Lee ◽

Dong Jin Shin

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Memory Impairment ◽

Limbic Encephalitis ◽

Clinical Symptoms ◽

Antibody Test ◽

Resonance Imaging ◽

First Case ◽

Autoimmune Limbic Encephalitis ◽

The Relationship

Anti-leucine-rich glioma inactivated-1 (LGI1) antibody has been known as the most common antibody in autoimmune limbic encephalitis. We report a case of a 63-year-old woman who presented with repetitive memory impairment. She was diagnosed with anti-LGI1 limbic encephalitis by clinical symptoms, magnetic resonance imaging, electroencephalography, and antibody test. Hepatocellular carcinoma (HCC) was discovered incidentally. Clinical seizures were completely controlled after hepatic segmentectomy without immunotherapy. This is the first case report showing the relationship between HCC and anti-LGI1 limbic encephalitis.

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TOCILIZUMAB IS EFFECTIVE IN AUTOIMMUNE LIMBIC ENCEPHALITIS REFRACTIVE TO WEEKLY RITUXIMAB

10.26226/morressier.56e174d4d462b8028d88a85c ◽

2016 ◽

Author(s):

Jung-Ah Lim

Keyword(s):

Limbic Encephalitis ◽

Autoimmune Limbic Encephalitis

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Autoimmune Limbic Encephalitis: When Psychiatric Symptoms Are Not What They Seem

10.26226/morressier.588f064fd462b8028d891808 ◽

2017 ◽

Author(s):

Ana Samico

Keyword(s):

Limbic Encephalitis ◽

Psychiatric Symptoms ◽

Autoimmune Limbic Encephalitis

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Paraneoplastic Limbic Encephalitis Secondary To Mixed Non-Seminomatous Germ Cell Tumours

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.119 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S55-S56

Author(s):

A Ullah ◽

S Heneidi ◽

P Biddinger ◽

N Patel ◽

C Wehrle ◽

...

Keyword(s):

Germ Cell ◽

Limbic Encephalitis ◽

Germ Cell Tumors ◽

Testicular Tumor ◽

Primary Malignancy ◽

Rare Presentation ◽

Paraneoplastic Limbic Encephalitis ◽

Nonseminomatous Germ Cell Tumor ◽

Aortic Lymph Node ◽

Alteration Of Consciousness

Abstract Casestudy: Testicular tumors account for 1–2% of all tumors in men, with 95% of these being germ cell tumors. The main risk factor for the development of testicular cancer is cryptorchidism. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumor associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy. We present a 41-year-old male that presented to the emergency department with two weeks of episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right sided testicular mass. Right radical orchiectomy was performed. Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated in-situ germ cell neoplasia. Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids resulted in resolution of the encephalitis. This presentation of severe neurological disturbances in the setting of a metastatic mixed nonseminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.

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