A 47-Year-Old Woman with Seizure and Rapidly Progressive Dementia

Case Report

Austin J Clin Neurol 2017; 4(2): 1103.

A 47-Year-Old Woman with Seizure and Rapidly Progressive Dementia

Haeri G, Razmeh S, Almasi-Dooghaee M*, Habibi AH, Sina F and Ghurchian Z

Department of Neurology, Iran University of Medical Sciences, Iran

*Corresponding author: Mostafa Almasi-Dooghaee, Department of Neurology, Iran University of Medical Sciences, Rasoul-e-Akram Hospital, Niayesh St, Sattarkhan ST, Tehran, Iran

Received: January 24, 2017; Accepted: March 16, 2017; Published: March 24, 2017


Paraneoplastic encephalitis is a rare autoimmune inflammatory disorder which can be associated with different malignancies. Its common symptoms are personality and behavioral disorders, seizure, confusion, mental decline and abnormal movements. It may manifest itself before the presentation of underlying malignancy and can cause permanent neurologic sequels despite treatment of cancer. It is recommended that the physician should be aware of the ambiguous symptoms of paraneoplastic disorders to perform investigations in order to find the true diagnosis and treat promptly. We report a patient with seizure and rapidly progressive dementia with a diagnosis of anti-voltage-gated potassium channel (VGKC) encephalitis as the first presentation of small cell lung carcinoma (SCLC).

Keywords: Small cell lung carcinoma; Paraneoplastic encephalitis; Anti voltage-gated potassium channel


Paraneoplastic encephalitis is an autoimmune inflammatory disorder of the central nervous system and is associated with different malignancies including breast, testis, bladder and thymus tumors and lymphoma; however, approximately eighty percent of reported cases are due to small cell lung cancer (SCLC) [1,2]. It usually occurs at middle age with a subacute onset and steady progression over a period of weeks to months. The usual symptoms and signs are sleep and personality disorders, depression, anxiety, partial and generalized seizures, hallucination, delusion, cognitive decline and abnormal movements [3]. This syndrome may precede the diagnosis of malignancy by months or years; In other words, it can present rarely as the first manifestation of cancer [4]. We present a case of paraneoplastic limbic encephalitis with antibody against voltagegated potassium channel as a first manifestation of SCLC that was followed for several months.

Case Presentation

A 47- year-old Iranian woman was admitted in neurology ward of Rasoul Akram hospital due to frequent generalized tonic seizures. The patient developed fever, headache, agitation, paranoid hallucination and frequent seizures about 40 days prior to admission in our hospital and was treated with the diagnosis of herpes encephalitis in another medical center but the lack of improvement led to referring to our hospital for further investigations. She didn’t take any medications before beginning of symptoms and her family history and review of systems were noncontributory. She denied any history of seizures before this presentation.

On physical examination, she was awake and the vital signs were normal. She had normal heart rate and regular cardiac rhythm and no cardiac murmur was detected. The lungs had not any significant findings on examination. The breasts examination was normal without any rash, mass, or other abnormal signs. The abdomen was soft with normal size of liver and spleen. Also, the Extremities had not any remarkable findings.

In the neurological examination, the Mini-Mental State Examination (MMSE) score was 20 out of 30. In details, the sub scores of registration, attention, calculation and recall were impaired. All of the cranial nerves were completely normal. Muscle strength and all deep tendon reflexes were normal and plantar responses were flexor bilaterally.

Fluid-attenuated inversion recovery (FLAIR) and T2-weighted MRI scan of brain revealed high intensity changes in bilateral medial temporal lobes (Figure 1). The routine cerebrospinal fluid (CSF) parameters including leukocyte count and protein were in normal range and the result of polymerase chain reaction (PCR) for herpes simplex DNA in CSF was negative, on two separate occasions. Electroencephalogram (EEG) showed diffuse background slowing and scattered epileptiform discharges including generalized spike and wave complexes.

Citation: Haeri G, Razmeh S, Almasi-Dooghaee M, Habibi AH, Sina F and Ghurchian Z. A 47-Year-Old Woman with Seizure and Rapidly Progressive Dementia. Austin J Clin Neurol 2017; 4(2): 1103. ISSN:2381-9154