A Case of Paraneoplastic Limbic Encephalitis Presented with Schizophrenic Symptoms

Kyu Sik Shin; Eun Jin Cheon; Se-Jin Lee

doi:10.4306/jknpa.2015.54.4.596

Journal List > J Korean Neuropsychiatr Assoc > v.54(4) > 1017779

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Shin, Cheon, and Lee: A Case of Paraneoplastic Limbic Encephalitis Presented with Schizophrenic Symptoms

Case Report

Journal of Korean Neuropsychiatric Association 2015; 54(4): 596-599.

Published online: 30 November 2015

DOI: https://doi.org/10.4306/jknpa.2015.54.4.596

A Case of Paraneoplastic Limbic Encephalitis Presented with Schizophrenic Symptoms

Kyu Sik Shin, MD¹, Eun Jin Cheon, MD², Se-Jin Lee, MD, PhD¹

¹Department of Neurology, College of Medicine, Yeungnam University, Daegu, Korea.

²Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Korea.

Address for correspondence: Se-Jin Lee, MD, PhD. Department of Neurology, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel +82-53-620-3683, Fax +82-53-627-1688, sejinmayo@ynu.ac.kr

Received 2 July 2015 Revised 13 August 2015 Accepted 18 August 2015

Abstract

Paraneoplastic limbic encephalitis associated with ovarian teratoma has variable clinical manifestations, including hallucination, abnormal behavior, amnesia, mental change, fever, chorea and dystonia, and often has antibodies to N-methyl-D-aspartate receptor (NMDAR), however cases without tumor or antibodies to NMDAR have also been reported. Here, we describe a 35-year-old female who was initially misdiagnosed as schizophrenia because she presented with acute onset of psychiatric symptoms, including visual hallucination, abnormal behavior, confusion, and memory impairment. Three days after admission, she developed high fever refractory to antibiotics. Brain MRI and examination of cerebrospinal fluid were normal. Computerized tomography of the pelvis showed an ovarian teratoma. The patient showed complete improvement after surgical removal of the ovarian teratoma and steroid therapy. We suggest that physicians should consider the possibility of paraneoplastic limbic encephalitis in patients who present with acute onset of psychiatric symptoms with high fever or movement disorder.

Keywords: Limbic encephalitis, Paraneoplastic, Ovarian teratoma, Schizophrenia

Figures and Tables

Fig. 1

The initial brain MRI of the patient. The axial fluid attenuation inversion recovery imaging shows no abnormalities.

Fig. 2

Pelvic CT of the patient. Pelvic CT demonstrates 5.5 cm sized cystic mass lesion containing calcification and fat in the right adnexa (arrow).

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

References

1. Thieben MJ, Lennon VA, Boeve BF, Aksamit AJ, Keegan M, Vernino S. Potentially reversible autoimmune limbic encephalitis with neuronal potassium channel antibody. Neurology. 2004; 62:1177–1182.

2. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000; 123(Pt 7):1481–1494.

3. Aydiner A, Gürvit H, Baral I. Paraneoplastic limbic encephalitis with immature ovarian teratoma--a case report. J Neurooncol. 1998; 37:63–66.

4. Cho HJ, Jo JW, Park KP, Kim DS, Park KH, Jung DS. A case of paraneoplastic limbic encephalitis associated with immature ovarian teratoma. J Korean Neurol Assoc. 2003; 21:647–650.

5. Lee HS, Kim SW, Chung SJ, Yoo HS, Lee PH, Choi SA. Anti-NMDA receptor encephalitis which has shown clinical symptoms of schizophrenia. J Korean Neurol Assoc. 2013; 31:115–117.

6. Granerod J, Crowcroft NS. The epidemiology of acute encephalitis. Neuropsychol Rehabil. 2007; 17:406–428.

7. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010; 10:835–844.

8. Lee EM, Kang JK. Autoimmune encephalitis. J Neurocrit Care. 2013; 6:8–15.

9. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008; 7:1091–1098.

10. Cakirer S. Paraneoplastic limbic encephalitis: case report. Comput Med Imaging Graph. 2002; 26:55–58.

11. Lennox BR, Coles AJ, Vincent A. Antibody-mediated encephalitis: a treatable cause of schizophrenia. Br J Psychiatry. 2012; 200:92–94.

12. Irani SR, Vincent A. NMDA receptor antibody encephalitis. Curr Neurol Neurosci Rep. 2011; 11:298–304.

13. Malter MP, Helmstaedter C, Urbach H, Vincent A, Bien CG. Antibodies to glutamic acid decarboxylase define a form of limbic encephalitis. Ann Neurol. 2010; 67:470–478.

14. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009; 65:424–434.

15. Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010; 9:67–76.

16. Kim SH, Kim HY, Im YT, Nam SO, Kim YM. A case of paraneoplastic limbic encephalitis due to ovarian mature teratoma. Korean J Pediatr. 2010; 53:603–606.

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