J Neurocrit Care.  2020 Jun;13(1):61-64. 10.18700/jnc.190105.

Nonconvulsive status epilepticus associated with leptomeningeal carcinomatosis and positive SOX1 antibodies

• Kim JY
• Kim GY
• Jeong JH
• Kim SH

• KMID: 2503387
• DOI: http://doi.org/10.18700/jnc.190105

Abstract

Background
Nonconvulsive status epilepticus (NCSE) is a disorder with varying prognoses depending on the underlying etiology. It is increasingly recognized as a cause of altered mental status but is difficult to diagnose without continuous electroencephalogram (EEG) monitoring.
Case Report
A 75-year-old woman visited our emergency department with acute altered mental status. A cerebrospinal fluid study showed meningeal carcinomatosis. The EEG showed NCSE. Brain magnetic resonance imaging showed diffuse meningeal enhancement around the brain stem. There were no other masses except suspected primary lung cancer on chest computed tomography. However, no malignant cells were detected in a bronchial washing. Levels of carbohydrate antigen 19-9 (CA19-9), CA125, and CA 15-3 were elevated. Autoimmune antibodies were all negative except for SOX1. The patient was unresponsive to first intrathecal chemotherapy and expired two days later.
Conclusion
This is a case report of NCSE caused by paraneoplastic autoimmune encephalitis associated with SOX1 antibodies.

Keyword

Nonconvulsive status epilepticus; Meningeal carcinomatosis; SOX1 antibodies

Figure

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  Figure 1. Initial waking electroencephalography showed semirhythmic delta activity which showed responsiveness (arrow) after 2 mg intravenous lorazepam injection.

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  Figure 2. (A-D) Brain magnetic resonance imaging shows meningeal enhancement around brainstem with focal nodular enhancement (arrows).

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  Figure 3. (A-D) Chest computed tomography showing focal mass like conolidation in left lower lobe posterior basal segment medial aspect.

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  Figure 4. Cytologic examination of the cerebrospinal fluid shows a few clusters of cells with enlarged eccentric nucleoli, prominent nucleoi and bubbly cytoplasm, suggesting metastatic adenocarcinoma (Papanicolaou stain, ×100).

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