title: Paraneoplastic limbic encephalitis resembling acute herpetic encephalitis.
abstract: Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance.
authors.affiliation: Department of Neurology, "St. Panteleimon" General State Hospital of Piraeus, 18454 Nikaia, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Markakis
authors.affiliation: Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex RM7 0AG, UK.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papathanasiou
authors.affiliation: Department of Neurology, "St. Panteleimon" General State Hospital of Piraeus, 18454 Nikaia, Greece.
authors.forename: Ermioni
authors.initials: E
authors.lastname: Papageorgiou
authors.affiliation: Department of Neurology, "St. Panteleimon" General State Hospital of Piraeus, 18454 Nikaia, Greece.
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Siarkos
authors.affiliation: Department of Neurology, "St. Panteleimon" General State Hospital of Piraeus, 18454 Nikaia, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gkekas