Xia Zongqi, Mehta Brijesh P, Ropper Allan H, Kesari Santosh
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
J Med Case Rep. 2010 Mar 24;4:95. doi: 10.1186/1752-1947-4-95.
Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poor outcome if it is not recognized and treated early in the course of the disease.
A 65-year-old Caucasian woman presented with generalized tonic-clonic seizures and increasing confusion shortly after a lung biopsy that led to the diagnosis of small-cell lung cancer. She had a complicated hospital course, and had recurrent respiratory distress due to aspiration pneumonia, and fluctuating mental status and seizures that were refractory to anti-epileptic drug treatment. Routine laboratory testing, magnetic resonance imaging of the brain, electroencephalogram, lumbar puncture, serum and cerebrospinal fluid tests for paraneoplastic antibodies, and chest computed tomography were performed on our patient. The diagnosis was paraneoplastic limbic encephalitis in the setting of small-cell lung cancer with positive N-type voltage-gated calcium channel antibody titer. Anti-epileptic drugs for seizures, chemotherapy for small-cell lung cancer, and intravenous immunoglobulin and steroids for paraneoplastic limbic encephalitis led to a resolution of her seizures and improved her mental status.
Early recognition of paraneoplastic limbic encephalitis and prompt intervention with immune therapies at the onset of presentation will probably translate into more favorable neurological outcomes.
副肿瘤性边缘叶脑炎仍然是一项具有挑战性的临床诊断，如果在疾病过程中未得到早期识别和治疗，预后较差。
一名65岁的白人女性在肺活检后不久出现全身强直阵挛性发作并逐渐出现意识模糊，肺活检诊断为小细胞肺癌。她的住院过程复杂，因吸入性肺炎反复出现呼吸窘迫，精神状态波动，癫痫发作对抗癫痫药物治疗无效。对我们的患者进行了常规实验室检查、脑部磁共振成像、脑电图、腰椎穿刺、血清和脑脊液副肿瘤抗体检测以及胸部计算机断层扫描。诊断为小细胞肺癌合并副肿瘤性边缘叶脑炎，N型电压门控钙通道抗体滴度呈阳性。用于癫痫发作的抗癫痫药物、用于小细胞肺癌的化疗以及用于副肿瘤性边缘叶脑炎的静脉注射免疫球蛋白和类固醇使她的癫痫发作得到缓解，精神状态有所改善。
早期识别副肿瘤性边缘叶脑炎并在出现症状时立即进行免疫治疗干预可能会带来更有利的神经学预后。
