University Department of Anaesthesiology, Resuscitation and Intensive Care, Sveti Duh Clinical Hospital, HR-10000 Zagreb, Croatia.
J Clin Anesth. 2013 Sep;25(6):491-5. doi: 10.1016/j.jclinane.2013.03.014. Epub 2013 Aug 17.
Paraneoplastic limbic encephalitis is a rare clinical entity characterized by the development of neuropsychiatric symptoms associated with malignancies. A case of a woman who presented to the Emergency Department with abdominal pain, hyperglycemia, and altered mental status is presented. After initial stabilization and correction of hyperglycemia the patient underwent emergency surgery. Laparotomy showed marked dilatation and gangrenous changes of the colon and tumor in the sigmoid colon. She was mechanically ventilated and remained ventilator-dependent for 42 days. Most of the time she was febrile; fever persisted with peaks up to 40° C despite various antibiotic treatments. On neurological examination, the patient was somnolent with left-sided hemiparesis. Magnetic resonance imaging (MRI) showed hyperintensities in both hippocampal areas, and electroencephalography (EEG) showed sharp-wave activity in the temporal lobes. Cerebrospinal fluid (CSF) examination showed slightly elevated protein levels, and laboratory assessments showed an elevated titer of anti-Yo antibodies. Although we do not have pathological confirmation of limbic encephalitis, the diagnosis of paraneoplastic limbic encephalitis was presumed on the basis of MRI findings, EEG abnormality, elevated CSF protein, positive anti YO antibodies, and neurological findings.
副肿瘤性边缘叶脑炎是一种罕见的临床实体，其特征为神经精神症状与恶性肿瘤相关。本文报告了 1 例以腹痛、高血糖和精神状态改变为表现的女性患者。在初始稳定和高血糖纠正后，患者接受了紧急手术。剖腹探查显示结肠显著扩张和坏疽性改变，乙状结肠有肿瘤。患者接受了机械通气，依赖呼吸机 42 天。大部分时间她都发烧；尽管进行了各种抗生素治疗，发热仍持续存在，峰值高达 40°C。神经系统检查时，患者嗜睡，左侧偏瘫。磁共振成像（MRI）显示双侧海马区高信号，脑电图（EEG）显示颞叶尖波活动。脑脊液（CSF）检查显示蛋白水平略有升高，实验室评估显示抗 Yo 抗体滴度升高。尽管我们没有边缘叶脑炎的病理证实，但根据 MRI 结果、脑电图异常、CSF 蛋白升高、抗 Yo 抗体阳性和神经学发现，我们推测诊断为副肿瘤性边缘叶脑炎。
