Omatuku Wetshosele Grégory, Bouazza Salima, Manto Mario, Moradi Massoud, Duran Derijckere Ivan
Nuclear Medicine, University Hospital Center of Charleroi (CHU Charleroi), Charleroi, BEL.
Neurology, University Hospital Center of Charleroi (CHU Charleroi), Charleroi, BEL.
Cureus. 2025 May 12;17(5):e83988. doi: 10.7759/cureus.83988. eCollection 2025 May.
Limbic encephalitis is a relatively rare autoimmune neurological disorder, typically diagnosed based on clinical symptoms lasting less than three months, including seizures, memory deficits, psychiatric symptoms, bilateral mesial temporal lesions on MRI, inflammatory cerebrospinal fluid, and epileptiform activity on electroencephalogram (EEG). We report the case of a female patient who presented with an inaugural epileptic seizure, for which MRI, lumbar puncture, and cerebral positron emission tomography (PET) scan showed no pathological findings. The patient re-presented to the emergency department one month later with recurrent seizures. A subsequent PET scan revealed the emergence of a right mesial temporal lesion, and a hypermetabolic pulmonary lesion was identified, which was later diagnosed as small-cell lung carcinoma on histopathology. The patient showed favorable clinical improvement under Solu-Medrol treatment, and a follow-up imaging performed several months later showed complete resolution of the hypermetabolic cerebral lesion after chemotherapy. This case highlights an unprecedented early stage of limbic encephalitis, characterized by an initial absence of inflammation, suggesting that this might represent a nascent phase of the disease, which could be crucial for future management of similar cases.
边缘叶脑炎是一种相对罕见的自身免疫性神经系统疾病，通常根据持续时间少于三个月的临床症状进行诊断，这些症状包括癫痫发作、记忆缺陷、精神症状、磁共振成像（MRI）显示双侧内侧颞叶病变、炎性脑脊液以及脑电图（EEG）上的癫痫样活动。我们报告了一例女性患者，其首发癫痫发作时，MRI、腰椎穿刺和脑正电子发射断层扫描（PET）均未发现病理结果。一个月后，该患者因癫痫复发再次就诊于急诊科。随后的PET扫描显示右侧内侧颞叶出现病变，同时发现一个代谢亢进的肺部病变，组织病理学检查后来诊断为小细胞肺癌。该患者在接受甲泼尼龙治疗后临床症状明显改善，数月后进行的随访成像显示化疗后代谢亢进的脑病变完全消失。该病例突出了边缘叶脑炎前所未有的早期阶段，其特征是最初不存在炎症，这表明这可能代表疾病的初始阶段，这对未来类似病例的管理可能至关重要。
