title: Paraneoplastic neuropsychiatric syndrome presenting as delirium.
abstract: Delirium in patients with cancer is associated with poor outcomes, but reversible causes need to be ruled out. We report the case of a 59-year-old woman who was presented with behavioural and cognitive changes over 2 weeks. She was non-verbal and combative, requiring involuntary admission and declaration of incompetence to make healthcare treatment decisions. Infectious and metabolic investigations and initial brain imaging were unremarkable. She was diagnosed with limited-stage small cell lung cancer and a paraneoplastic neuropsychiatric syndrome. Owing to the patient's delirium, chemotherapy delivery required pharmacological and physical restraints. After 2 cycles of chemotherapy, she could participate in the decision process and was discharged home. She completed radical chemo-radiotherapy and has remained free of disease progression for 18 months. Paraneoplastic neuropsychiatric syndromes, although rare, are potentially treatable and need to be excluded as a cause of delirium.
authors.affiliation: Division of Medical Oncology, Department of Oncology, Faculty of Medicine, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gloria
authors.initials: G
authors.lastname: Roldan Urgoiti
authors.affiliation: Division of Palliative Medicine, Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|Palliative & End of Life Care, Alberta Health Services (AHS), Calgary Zone, Calgary, Alberta, Canada.
authors.forename: Aynharan
authors.initials: A
authors.lastname: Sinnarajah
authors.affiliation: Division of Palliative Medicine, Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Seema
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Division of Medical Oncology, Department of Oncology, Faculty of Medicine, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Desiree
authors.initials: D
authors.lastname: Hao
mesh_terms: D018288:Carcinoma, Small Cell / Q000150:complications*; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008875:Middle Aged; D020364:Paraneoplastic Polyneuropathy / Q000175:diagnosis* / Q000209:etiology
keywords: Paraneoplastic syndrome; case report; small cell lung cancer