Paraneoplastic recurrent multifocal encephalitis presenting with epilepsia partialis continua.
We report a 46-year-old female patient in whom epilepsia partialis continua was the initial presentation of small cell lung cancer. Magnetic resonance imaging revealed multiple, bilateral cortical lesions, which were originally misinterpreted and treated as brain metastases. Intracranial lesions and neurological symptoms remitted after corticosteroids, chemotherapy, and radiotherapy. After an asymptomatic interval of 18 months, neurological symptoms recurred with more extensive involvement of completely different parts of the central nervous system (limbic, brainstem and cerebellar structures) without any evidence of tumor recurrence. Both episodes showed a distinctive response to immunosuppressive therapy. The diagnostic challenges of the highly variable clinical presentations and therapeutic approaches to paraneoplastic multifocal encephalitis are discussed with relevant literature review.
Mut
Melike
M
Department of Neurosurgery, University of Virginia, CDW Hospital Drive, P.O. Box 800212, Charlottesville, VA 22903, USA. mm2ee@hscmail
Schiff
David
D
Dalmau
Josep
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017036:Epilepsia Partialis Continua / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents