Akiyama Natsuki, Miwa Yamato, Umeda Yoshitaka, Tanaka Keiko, Oyake Mutsuo, Fujita Nobuya
Department of Neurology, Nagaoka Red Cross Hospital.
Department of Animal Model Development, Brain Research Institute, Niigata University.
Rinsho Shinkeigaku. 2020 Dec 26;60(12):869-873. doi: 10.5692/clinicalneurol.cn-001503. Epub 2020 Nov 20.
An 84-year-old man was admitted to our hospital with new-onset refractory status epilepticus of unclear etiology. On the third day, diffusion-weighted brain MRI demonstrated lesions in the right medial temporal and parietal lobes. As a CSF sample showed pleocytosis, paraneoplastic limbic encephalitis (PLE) associated with small cell lung cancer (SCLC) was suspected. The patient was also positive for anti-gamma aminobutyric acid (GABA) receptor antibody in the CSF, which has recently been reported in elderly patients with SCLC-related PLE. Methylprednisolone pulse therapy ameliorated the symptoms. It is noteworthy that immune therapy often improves the symptoms of PLE with anti-GABA receptor antibody, even though radical therapy for the lung cancer may be difficult.
一名84岁男性因病因不明的新发难治性癫痫持续状态入住我院。第三天,脑部弥散加权磁共振成像显示右侧颞叶内侧和顶叶有病变。由于脑脊液样本显示细胞数增多,怀疑为与小细胞肺癌(SCLC)相关的副肿瘤性边缘叶脑炎(PLE)。该患者脑脊液中抗γ-氨基丁酸(GABA)受体抗体也呈阳性,最近在老年SCLC相关PLE患者中已有报道。甲泼尼龙冲击疗法使症状得到改善。值得注意的是,尽管肺癌的根治性治疗可能困难,但免疫疗法通常能改善抗GABA受体抗体所致PLE的症状。