Villanueva-Castro Eliezer, Hernández Reséndiz Rebeca, Munuzuri-Camacho Marco Antonio, Coutinho Thomas Domingo J, Jiménez-Quintero Luz de Alicia, Cacho-Díaz Bernardo, Reyes-Moreno Ignacio, Gutierrez-Aceves Guillermo A, Guerrero-Juarez Vicente, Ramirez-Bermudez Jesus, González-Aguilar Alberto
Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.
Department of Neurology, Hospital Angeles Universidad, Mexico City, MEX.
Cureus. 2025 May 11;17(5):e83899. doi: 10.7759/cureus.83899. eCollection 2025 May.
Limbic encephalitis (LE) is an inflammatory syndrome affecting the limbic system, often presenting with seizures, memory impairment, and behavioral disturbances. While autoimmune and infectious causes are common, gliomas can mimic this condition, leading to diagnostic challenges.
A retrospective review of glioma cases initially diagnosed as LE was conducted at two centers in Mexico (The American British Cowdray and National Institute of Neurology and Neurosurgery) from 2010 to 2022. Inclusion criteria included acute clinical presentation, magnetic resonance imaging (MRI) T2 hyperintensities in the limbic system, lumbar puncture, paraneoplastic panel, cerebrospinal fluid (CSF) viral studies, and histopathological confirmation. Patients with infectious, autoimmune, or other identified etiologies were excluded.
Nine patients (mean age 45.2 years; six males, three females) met the criteria. Initial presentations included seizures (5/9), encephalopathy (5/9), fever (1/9), and psychotic symptoms (2/9). MRI revealed limbic system hyperintensities with minimal contrast enhancement. Spectroscopy and perfusion MRI findings suggested low-grade gliomas (LGGs). Histopathology confirmed astrocytoma (5/9), oligoastrocytoma (3/9), and oligodendroglioma (1/9). All patients received steroids, and some received additional therapies (plasma exchange (PLEX), acyclovir, immunoglobulin).
Gliomas can present as LE, leading to potential misdiagnosis. Advanced imaging and histopathological confirmation are essential for accurate differentiation, ensuring appropriate treatment and improved patient outcomes.
边缘叶脑炎（LE）是一种影响边缘系统的炎症综合征，常表现为癫痫发作、记忆障碍和行为紊乱。虽然自身免疫性和感染性病因较为常见，但胶质瘤可模仿这种病症，导致诊断困难。
对2010年至2022年在墨西哥的两个中心（美英考德里医院和国家神经病学与神经外科研究所）最初诊断为LE的胶质瘤病例进行回顾性研究。纳入标准包括急性临床表现、边缘系统磁共振成像（MRI）T2高信号、腰椎穿刺、副肿瘤检测、脑脊液（CSF）病毒学研究以及组织病理学确诊。排除有感染、自身免疫或其他明确病因的患者。
9例患者（平均年龄45.2岁；6例男性，3例女性）符合标准。初始表现包括癫痫发作（5/9）、脑病（5/9）、发热（1/9）和精神症状（2/9）。MRI显示边缘系统高信号，增强扫描强化不明显。波谱分析和灌注MRI结果提示为低级别胶质瘤（LGGs）。组织病理学确诊为星形细胞瘤（5/9）、少突星形细胞瘤（3/9）和少突胶质细胞瘤（1/9）。所有患者均接受了类固醇治疗，部分患者还接受了其他治疗（血浆置换（PLEX）、阿昔洛韦、免疫球蛋白）。
胶质瘤可表现为LE，导致潜在的误诊。先进的影像学检查和组织病理学确诊对于准确鉴别至关重要，可确保恰当的治疗并改善患者预后。
