Original ArticleClinical, Magnetic Resonance Imaging, and Electroencephalographic Findings in Paraneoplastic Limbic Encephalitis
Section snippets
Clinical Material
We used the Mayo Clinic medical records linkage system to identify 24 patients (seen at the Mayo Clinic in Rochester, Minn, between 1985 and 2002) in whom PLE was suspected. The study was approved by the Mayo Foundation Institutional Review Board. Paraneoplastic limbic encephalitis was defined as cognitive changes, seizures, or psychiatric symptoms having a subacute onset (during a period <6 months) and accompanied by histological confirmation of malignancy. Cases were excluded if another
Clinical Features
We identified 24 patients with PLE (Table 1); 2 patients were reported previously.15, 16 The median age was 61 years (range, 23-72 years). Thirteen patients had histologically proven SCLC; the other 11 had other types of cancer (3 breast adenocarcinoma, 2 thymoma, 1 testicular embryonal cell carcinoma, 1 testicular seminoma, 1 renal cell carcinoma, 1 lung carcinoid tumor, 1 lung adenocarcinoma, and 1 lung squamous cell carcinoma). In most patients (18/24), neurologic symptoms preceded the
Discussion
Laboratory investigations play an important role in the evaluation of suspected PLE. This diagnosis should be suspected in any patient with subacute onset of cognitive impairment, particularly when associated with seizures. However, clinical seizures are not a constant feature, and PLE also must be considered in the differential diagnosis of patients with a subacute psychiatric presentation. Our findings are similar to those reported in previous studies of PLE,4, 17 but our study has several
Conclusions
The identification of limbic dysfunction without definable cause should suggest the possibility of PLE and lead to a search for occult malignancy. Investigations should be performed to confirm cerebral dysfunction, show involvement of temporolimbic structures, and exclude meningoencephalitis due to infectious or carcinomatous processes. The EEG is invariably abnormal, reflecting the presence of cerebral dysfunction predominantly involving the temporal regions. Detection of epileptiform
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Dr Lawn is now with the Royal Perth Hospital, Perth, Australia.