Boangher Sabina, Mespouille Pascal, Filip Corina-Mihaela, Goffette Sophie
Department of Neurology, Arlon Hospital, No. 137, Rue des Déportés, 6700 Arlon, Belgium.
Oncology Department, CH Luxembourg, Rue Nicolas-Ernest Barblé, No. 4, L 1210 Luxembourg, Luxembourg.
Case Rep Neurol Med. 2016;2016:3263718. doi: 10.1155/2016/3263718. Epub 2016 Dec 13.
We report the case of a 66-year-old woman, with paraneoplastic limbic encephalitis, treated 6 months earlier for bladder neoplasia. The patient presented to the emergency room with rapidly increasing symptoms, noninfectious cerebral spinal fluid associated with positive anti-NMDAR (as well as in serum) and positive AMPAR antibodies in the serum. Four months later, the patient was diagnosed with a small-cell lung cancer for which chemotherapy and radiotherapy was commenced. Simultaneously, endoscopic surgical treatment was undertaken for an in situ relapse of the bladder neoplasm. After the completion of 3 cycles of chemotherapy her neurological status temporarily worsened. The cerebral MRI did not show signs of encephalitis such as increased T2/FLAIR signal intensity in the mesial temporal lobes and limbic systems. No specific treatment was prescribed. Limbic encephalitis can be associated with malignant tumors such as lung carcinoma. Several cases reported in the literature have shown cognitive improvement after tumoral therapy. Regarding our experience, significant progress was achieved through immuno-modulatory treatment. A transitory deterioration of the cognitive process was perceived during the chemotherapy sessions.
我们报告了一例66岁患有副肿瘤性边缘叶脑炎的女性病例，该患者6个月前因膀胱肿瘤接受过治疗。患者因症状迅速加重就诊于急诊室，脑脊液无感染迹象，抗NMDAR抗体阳性（血清中也呈阳性），血清中AMPAR抗体阳性。4个月后，患者被诊断为小细胞肺癌，并开始进行化疗和放疗。同时，对膀胱肿瘤原位复发进行了内镜手术治疗。在完成3个周期的化疗后，她的神经状态暂时恶化。脑部MRI未显示脑炎迹象，如内侧颞叶和边缘系统的T2/FLAIR信号强度增加。未进行特殊治疗。边缘叶脑炎可能与肺癌等恶性肿瘤有关。文献报道的几例病例显示肿瘤治疗后认知功能有所改善。就我们的经验而言，通过免疫调节治疗取得了显著进展。在化疗期间，认知过程出现了短暂恶化。
