Acute limbic encephalitis: diagnostic and management implications.
OBJECTIVE
A link between cancer and limbic encephalitis (LE) has been proposed. The aim of this case presentation is to further explore this association by literature review, inform clinicians of the investigations necessary to arrive at a diagnosis and to emphasize the clinical importance of liaison between psychiatry and other disciplines involved in management.


METHODS
The case report of a 55 year old Niuean male school teacher with an acute onset of confusion and personality change is presented. The clinical data was obtained from various sources including the emergency room, medical ward, psychiatric ward as well as from discussions with other physicians involved in the management of this case. Family members and friends were also contacted to obtain corroborative historical information.


RESULTS
LE was diagnosed in this case based on clinical presentation with psychiatric symptoms, ruling out delirium due to infections, metabolic and other toxins as well as magnetic resonance imaging findings confirming temporal lobe changes.


CONCLUSIONS
LE is a known paraneoplastic syndrome (PNS) that may precede the diagnosis of an underlying malignancy. Recent advances in laboratory technology now allow for antibodies to be identified in specific malignancies. This behooves the clinicians to maintain a high level of diagnostic suspicion so that timely interventions with oncology can follow.
Lucas-Ramadan
Tracey
T
Department of Psychiatry, Middlemore Hospital, Auckland, New Zealand.
Baxi
Shrujal
S
Velamoor
Raj
R
D000208:Acute Disease; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003221:Confusion / Q000175:diagnosis / Q000523:psychology; D003693:Delirium / Q000175:diagnosis / Q000523:psychology; D004569:Electroencephalography / Q000706:statistics & numerical data; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000379:methods; D020363:Limbic Encephalitis / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009520:New Zealand; D010348:Patient Care Team; D010951:Plasma Exchange; D010818:Practice Patterns, Physicians'; D011241:Prednisone / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013256:Steroids / Q000627:therapeutic use
D014150:Antipsychotic Agents; D016756:Immunoglobulins, Intravenous; D013256:Steroids; D002998:Clonazepam; D011241:Prednisone