J Clin Neurol.  2015 Jan;11(1):87-91. 10.3988/jcn.2015.11.1.87.

Paraneoplastic Limbic Encephalitis in a Male with Squamous Cell Carcinoma of the Lung

• Sauri T
• Izquierdo
• Ramio-Torrenta L
• Sanchez-Montanez A
• Bosch-Barrera J
• Porta R

• KMID: 2179577
• DOI: http://doi.org/10.3988/jcn.2015.11.1.87

Abstract

BACKGROUND
Paraneoplastic limbic encephalitis (PLE) is a rare syndrome characterized by memory impairment, symptoms of hypothalamic dysfunction, and seizures. It commonly precedes the diagnosis of cancer. Small-cell lung cancer is the neoplasm that is most frequently reported as the etiology underlying PLE.
CASE REPORT
This report describes a male patient who presented with neurologic symptoms consistent with anterograde amnesia, apathy, and disorientation. MRI revealed diffuse hyperintensities located predominantly in the medial bitemporal lobes, basal ganglia, frontal lobes, and leptomeninges on fluid attenuated inversion recovery images, suggesting PLE. Study of the primary tumor revealed squamous cell carcinoma of the lung. The patient was treated with neoadjuvant chemotherapy followed by surgery and adjuvant chemoradiotherapy, which resulted in his neurologic symptoms gradually improving.
CONCLUSIONS
PLE might be a rare debut of squamous cell carcinoma of the lung. Treatment of the primary tumor may improve the neurologic symptoms.

Keyword

lung cancer; squamous cell carcinoma; paraneoplastic syndrome; limbic encephalitis

MeSH Terms

Amnesia, Anterograde
Apathy
Basal Ganglia
Carcinoma, Squamous Cell*
Chemoradiotherapy, Adjuvant
Diagnosis
Drug Therapy
Frontal Lobe
Humans
Limbic Encephalitis*
Lung Neoplasms
Lung*
Magnetic Resonance Imaging
Male
Memory
Neurologic Manifestations
Paraneoplastic Syndromes
Seizures

Figure

• 

  Fig. 1 Brain fluid attenuated inversion recovery imaging performed before surgery showing a diffuse hyperintense signal within the medial temporal lobes and extending into the basal ganglia, frontal basal lobes, and leptomeninges (A). Avid and homogeneous enhancement was noted after administration of contrast medium (B).

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  Fig. 2 Brain fluid attenuated inversion recovery imaging performed after surgery depicting remarkable decreases in the extension and signal intensity within the medial region of both temporal lobes. Secondary mesial atrophy with temporal horn dilatation can be observed (A). No enhancement was observed after gadolinium injection (B).

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  Fig. 3 Histologic images of postmortem brain tissue showing a prominent atrophy of the anterior part of the hippocampus at low magnification (A) (hematoxylin-eosin stain) with marked segmental neuronal loss and loosening of the neuropil (arrows). At higher magnification, prominent reactive gliosis with abundant large gemistocytes (B1), some mineralizations (B1), and parenchymal and perivascular inflammatory cuffs (B2) were observed. Most of the parenchymal infiltrates were composed of CD8-positive T-cells (C), some of which were in close contact with morphologically intact neurons (arrows) (D).

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