Paraneoplastic Syndrome Presenting as Progressive Cognitive
Decline
S. A. Sathyapala, R. Bathula, T. A. R. Seemungal,
D. P. J. MacLeod and L. M. Kuitert
Department of Respiratory Medicine, Royal
London Hospital, Bart’s and the London NHS Trust, London,
UK.
Abstract
A number of paraneoplastic neurological syndromes
have been described in association with small cell lung carcinoma
and, less commonly, with other malignancies. We describe here
the case of a 58-year-old woman with paraneoplastic limbic encephalitis
(PLE) complicating squamous cell carcinoma of the lung.
She presented with subacute cognitive decline,
particularly memory loss, personality change and hallucinations.
She had a history of ischaemic heart disease and an undifferentiated
connective tissue disorder. Apart from a low titre of anti-nuclear
antibody, all blood and CSF tests were normal, including inflammatory
markers. CT scans of the brain demonstrated multiple low-density
lesions in the cortex and cerebellum, but MRI of the brain only
demonstrated lesions in the right frontal lobe and the right occipital
lobe which did not have the appearance of metastases. Trans-oesophageal
echocardiography, carotid doppler ultrasonography and a 24-hour
tape all failed to identify any source of embolus. EEG demonstrated
bilateral fronto-temporal changes.
Subsequently a suspicious right upper lobe lesion
on chest radiography was confirmed on CT, and bronchoscopy revealed
a second right lower lobe endobronchial mass; biopsy confirmed
squamous cell carcinoma.
Early recognition of paraneoplastic syndromes
like PLE should result in prompt diagnosis and
treatment of these cancers.
Key words
Paraneoplastic, encephalitis, squamous cell,
lung cancer
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