Anti-LGI1 Limbic Encephalitis Presented with Atypical Manifestations

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

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Aetiologies and anatomy of confabulation

10.1093/oso/9780198789680.003.0004 ◽

2017 ◽

Author(s):

Armin Schnider

Keyword(s):

Brain Damage ◽

Limbic Encephalitis ◽

Artery Aneurysm ◽

Anterior Communicating Artery ◽

Brain Areas ◽

Anatomical Basis ◽

Korsakoff Syndrome ◽

Hypoxic Brain ◽

Degenerative Dementia ◽

The Brain

What diseases cause confabulations and which are the brain areas whose damage is responsible? This chapter reviews the causes, both historic and present, of confabulations and deduces the anatomo-clinical relationships for the four forms of confabulation in the following disorders: alcoholic Korsakoff syndrome, traumatic brain injury, rupture of an anterior communicating artery aneurysm, posterior circulation stroke, herpes and limbic encephalitis, hypoxic brain damage, degenerative dementia, tumours, schizophrenia, and syphilis. Overall, clinically relevant confabulation is rare. Some aetiologies have become more important over time, others have virtually disappeared. While confabulations seem to be more frequent after anterior brain damage, only one form has a distinct anatomical basis.

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Atypical manifestations of COVID-19: to know signs and symptoms to recognize the whole disease in the Emergency Department

Internal and Emergency Medicine ◽

10.1007/s11739-020-02574-y ◽

2021 ◽

Author(s):

Danilo Pagliari ◽

Alessio Marra ◽

Roberto Cosentini

Keyword(s):

Emergency Department ◽

Signs And Symptoms ◽

Atypical Manifestations

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Paraneoplastic Limbic Encephalitis Secondary To Mixed Non-Seminomatous Germ Cell Tumours

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.119 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S55-S56

Author(s):

A Ullah ◽

S Heneidi ◽

P Biddinger ◽

N Patel ◽

C Wehrle ◽

...

Keyword(s):

Germ Cell ◽

Limbic Encephalitis ◽

Germ Cell Tumors ◽

Testicular Tumor ◽

Primary Malignancy ◽

Rare Presentation ◽

Paraneoplastic Limbic Encephalitis ◽

Nonseminomatous Germ Cell Tumor ◽

Aortic Lymph Node ◽

Alteration Of Consciousness

Abstract Casestudy: Testicular tumors account for 1–2% of all tumors in men, with 95% of these being germ cell tumors. The main risk factor for the development of testicular cancer is cryptorchidism. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumor associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy. We present a 41-year-old male that presented to the emergency department with two weeks of episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right sided testicular mass. Right radical orchiectomy was performed. Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated in-situ germ cell neoplasia. Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids resulted in resolution of the encephalitis. This presentation of severe neurological disturbances in the setting of a metastatic mixed nonseminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.

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