title: Squamous Cell Lung Carcinoma Presenting With Refractory Status Epilepticus: A Case Report of Paraneoplastic Limbic Encephalitis.
abstract: Lung cancer-associated paraneoplastic syndromes affecting the central nervous system present significant diagnostic and treatment challenges. In this case, the patient presented with personality change, cognitive impairment, complex partial seizures, ataxia, dyspraxia, and dysphasia. Shortly after admission, the patient suffered refractory generalized tonic-clonic seizures and a decreased level of consciousness and required intubation, ventilation, and admission to the ICU. He was subsequently diagnosed with paraneoplastic limbic encephalitis based on recognized criteria, including a compatible clinical picture, elevated protein content in his cerebrospinal fluid with negative cytology, a positive positron emission tomography-computed tomography scan showing a right upper lobe tumor, and the exclusion of other neuro-oncological complications. Histopathology confirmed the tissue diagnosis as squamous cell cancer. Initial immunotherapy with steroids and intravenous immunoglobulin and subsequent lobectomy and adjuvant chemotherapy were partially successful, leading to partial resolution of his cognitive impairment. This report highlights the diagnostic and therapeutic challenges of lung-related paraneoplastic syndromes. In addition, it illustrates the poor outcomes for patients and identifies squamous cell cancer as an extremely rare cause of paraneoplastic limbic encephalitis.
authors.affiliation: Department of Internal Medicine killian_hurley@yahoo.com.
authors.forename: Killian
authors.initials: K
authors.lastname: Hurley
authors.affiliation: Department of Internal Medicine.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Herron
authors.affiliation: Department of Internal Medicine.
authors.forename: Sean
authors.initials: S
authors.lastname: McDermott
authors.affiliation: Department of Radiology, St. James's Hospital, Dublin, Ireland.
authors.forename: Terence
authors.initials: T
authors.lastname: Farrell
authors.affiliation: Department of Internal Medicine.
authors.forename: Deirdre
authors.initials: D
authors.lastname: O'Riordan
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000150:complications*; D006801:Humans; D020363:Limbic Encephalitis / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D013226:Status Epilepticus / Q000209:etiology*
keywords: intensive care unit; limbic encephalitis; lung cancer; paraneoplastic syndrome; seizures; squamous cell carcinoma