Journal of

Case Reports and Images in Oncology

 
     
Case Report
 
Paraneoplastic limbic encephalitis in a patient with rectal adenocarcinoma: A rare entity
Kusum Hooda1, Nishant Gupta2, Charu Chanana3, Pranav Sharma1, Salil Sharma1, Joshua Sapire4
1Resident, Diagnostic Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, CT, USA.
2Resident, Diagnostic Radiology, St. Vincent Medical Center, Bridgeport, CT, USA, Bridgeport, CT, USA.
3Attending Obstetrician and Gynecologist, Bassett Healthcare Network, Cooperstown, NY USA.
4Clinical Assistant Instructor in Diagnostic Radiology, Yale New Haven Health System at Bridgeport Hospital.

Article ID: 100031Z10KH2017
doi:10.5348/Z10-2017-31-CR-2

Address correspondence to:
Kusum Hooda
267 Grant Street, Deptt of Diagnostic Radiology
Bridgeport, CT
USA 06610

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How to cite this article:
Hooda K, Gupta N, Chanana C, Sharma P, Sharma S, Sapire J. Paraneoplastic limbic encephalitis in a patient with rectal adenocarcinoma: A rare entity. J Case Rep Images Oncology 2017;3:6–10.


Abstract
Introduction: Paraneoplastic neurological syndromes are defined as remote effects of cancer, not caused by the tumor and its metastasis, or by metabolic disruptions or ischemia. Paraneoplastic limbic encephalitis (PLE) is one of them, and commonly have been described in patients with lung or breast cancer. Colon and rectal cancers have also been shown to be associated with PLE as in our case.
Case Report: We report a case of 56-year-old male who had been diagnosed with adenocarcinoma of the rectum one year ago. He initially responded well to systemic chemotherapy, resulting in symptomatic relief related to the primary disease. However, one year after the initial diagnosis, the patient presented with recurrent seizures and disorientation for few days. Magnetic resonance imaging (MRI) scan of the brain was performed which demonstrated findings of PLE. Serum analysis revealed a high titer of anti-Ri, an antibody shown to be associated with paraneoplastic neurologic syndromes. The patient's symptoms improved markedly after treatment with antiepileptic therapy (phenobarbital) and methylprednisolone. After two months follow-up MRI scan showed complete resolution of the abnormalities.
Conclusion: Paraneoplastic limbic encephalitis can complicate the patient's clinical course, response to treatment and affect the prognosis. In a patient with non-neurological malignancy presenting with new neurologic problems PLE should always be kept in the differential diagnosis. The characteristic MRI findings of these syndromes are very helpful in early diagnosis and excluding other causes.

Keywords: Antiepileptic, Anti-Ri antibody, Paraneoplastic limbic encephalitis, Rectal adenocarcinoma


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Author Contributions
Kusum Hooda – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nishant Gupta – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Charu Chanana – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Pranav Sharma – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Salil Sharma – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Joshua Sapire – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Kusum Hooda et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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