Journal List > Dement Neurocogn Disord > v.13(3) > 1120733

Dement Neurocogn Disord. 2014 Sep;13(3):79-82. Korean.
Published online Sep 30, 2014.  https://doi.org/10.12779/dnd.2014.13.3.79
© 2014 Korean Dementia Association
Non-paraneoplastic Autoantibody-negative Limbic Encephalitis Characterized by Mild Memory Impairment: A Case Report
SangWoo Han, M.D., JaeJeong Joo, M.D., JinHo Kang, M.D., Sang won Ha, M.D. and YoungSoon Yang, M.D.
Department of Neurology, VHS Medical Center, Seoul, Korea.

Address for correspondence: YoungSoon Yang, M.D. Department of Neurology, VHS Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 134-791, Korea. Tel: +82-2-2225-4106, Fax: +82-2-2225-4105, Email: astro76@naver.com
Received Aug 22, 2014; Revised Sep 02, 2014; Accepted Sep 02, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Encephalitis that primarily involves limbic system structures such as the hippocampus and parahippocampal gyrus has been described in early papers, most commonly characterized by a subacute progressive impairment of short-term memory, psychiatric features and seizures. While these findings might be caused by viral infections or systemic autoimmune disorders, many patients with limbic encephalitis have an immune-mediated etiology (paraneoplastic or not) characterized with serum or CSF antineuronal antibodies. This case reports about non-paraneoplastic autoantibody-negative limbic encephalitis in which there are no detection of antigens and no evidence of tumors.

Keywords: Limbic encephalitis; Memory impairment; Non-paraneoplastic; Autoantibody negative

Figures


Fig. 1
Axial brain MR T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) image show increased signal intensity in both medial temporal lobe (A, C). T1-weighted image (T1WI), Gadolium (Gd)-eahauced T1-weighted MRI and DWI study shows no hyperintensity on bilateral temporal lobes with isointensities on ADC map (B, D, E, F).
Click for larger image


Fig. 2
Brain FDG PET shows increased FDG uptake in the both medial temporal lobes, which is much worse on the left side.
Click for larger image


Fig. 3
EEG monitoring shows no epileptiform discharge.
Click for larger image


Fig. 4
Follow-up MRI after 2 weaks. FLAIR image shows some improvement compared to the previous study.
Click for larger image

References
1. Brierley JB, Corsellis JAN, Hierons R, Nevin S. Subacute encephalitis of alter adult life, mainly affecting the limbic areas. Brain 1960;83:357–368.
2. Kondziella D. Case report on non-paraneoplastic autoantibody-negative limbic encephalitis.
3. Won Y, Kim JY, Park HJ. A case of voltage gated potassium channel antibodies-associated nonparaneoplastic limbic encephalitis. J Korean Neurol Assoc 2006;24:148–152.
4. Vincent A, Bien CG, Irani SR, Waters P. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol 2011;10:759–772.
5. Kim MH, Oh SH, Shin DK. Limbic encephalitis caused by human herpesvirus-6 infection in allogenic hematopoietic stem cell transplantation patient. J Korean Neurol Assoc 2010;28:132–134.
6. Cho TY, Kim YJ, Lee BI. A case of limbic encephalitis associated with small cell lung? cancer-about diagnostic MRI Findings. J Korean Neurol Assoc 1994;12:338–342.
7. Cho HJ, Jo JW, Park KP. A case of paraneoplastic limbic encephalitis associated with immature ovarian teratoma. J Korean Neurol Assoc 2003;21:647–650.
8. Han SH, Chi HS. A case of paraneoplastic limbic encephalitis presenting anti-purkinje cell antibody. J Korean Neurol Assoc 2005;23:724–726.
9. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunologic findings and tumor association in 50 patients. Brain 2000;123:1481–1494.
10. Kim KK. Paraneoplastic syndrome. J Korean Neurol Assoc 2002;20:215–222.
11. Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology 2011;77:179–189.
12. Erdem TUZUN.Limbic Encephalitis Associated with Antibodies to Cell Membrane Antigens. Arch Neuropsychiatry 2007;44:101–107.