Submission Type

Case Report


Introduction: Paraneoplastic limbic encephalitis is a syndrome characterized by autoimmune inflammation of the limbic system in the setting of underlying malignancy. The syndrome presents with acute to subacute neuropsychiatric clinical findings, often before the cancer diagnosis is known.

Clinical Findings: A 57-year-old woman with a 30 pack-year smoking history presented to Maine Medical Center after multiple generalized tonic-clonic seizures. Her family reported periodic odd behavior including confusion, disinhibition, and paranoia--all of which preceded her first seizure by two weeks.

Diagnoses, interventions, and outcomes: MRI brain showed T2/FLAIR signal hyperintensity of the right amygdala and hippocampus with sparing of the right insular cortex and cingulate gyrus. Electroencephalogram showed frequent right temporal simple partial seizures. Cerebrospinal fluid was notable for mild pleocytosis and positive GABA-B-R antibodies with a titer of 1:32 (reference range

Conclusions: This case illustrates the importance of early diagnosis and treatment of the syndrome of paraneoplastic limbic encephalitis. The strong association with often undiagnosed malignancy underscores this importance; as well as the opportunity for early initiation of tumor treatment.



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