Paraneoplastic limbic encephalitis- forgotten etiology of altered sensorium

Abhishek Pathak, Sundaram Viswanath, Anvesh Rathore, A. P. Dubey


Paraneoplastic limbic encephalitis (PLE) is a rare disorder characterized by minor personality changes, irritability, depression, seizures, memory loss to frank altered sensorium. The diagnosis is difficult because clinical markers are often lacking, and symptoms usually precede the diagnosis of cancer or mimic other complications. The common causes of altered sensorium normally considered include infections, metabolic derangements, dyselectrolytemias, stroke, seizure, encephalitis etc. An oncological cause of altered sensorium is generally lower among the differentials. In absence of any overt signs of malignancy and probably due to less exposure to these cases, they generally get missed. Cancers primarily associated with limbic encephalitis are SCLC, breast cancer, thymomas, testicular malignancies, hodgkins and non hodgkins lymphoma. There have been reported cases for limbic encephalitis associated with adenocarcinoma of colon but not with adenocarcinoma of gastro esophageal junction. Our case of limbic encephalitis associated with adenocarcinoma of gastro esophageal junction is a rare entity and hence it isour endeavor to bring forth   this case.


Endoscopic third ventriculostomy, Hydrocephalus, VP shunt, Neuroendoscopy, CSF diversion procedure, ETV

Full Text:



Hensen RA, Urich HH. Encephalomyelitis with carcinoma. Brain. 1965;88:449.

Gultekin SH, Rosenfield MR, Voltz R. Paraneoplastic limbic encephalitis:neurological symptoms immunological findings and tumour association in 50 patient. Brain. 2000;123:1481.

Alamowitch SF, UchuyaGM, Renaea R, Bescansa E. Limbic encephalitis and small cell lung cancerClinical and immunological features. Brain. 1997;120, 923-8.

Graus F, Guibert KF, Rene R. Anti-Hu associated paraneoplastic encephalomyelitis:analysis of 200 patients. Brain. 2001;124:1138.

Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology. 1998;50:652.

Sillevis Smitt P, Grefkens J, de Leeuw B. Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol. 2002;249:745.

Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med. 2003; 349: 1543–54.

Basu S, Alavi A. Role of FDG-PET in the clinical management of paraneoplastic neurological syndrome: detection of the underlying malignancy and the brain PET-MRI correlates. Mol Imaging Biol. 2008;10:131.

Wingfield T, McHugh C, Vas A. Autoimmune encephalitis: a case series and comprehensive review of the literature. QJM. 2011;104:921.

Graus F, Dalmau SAJ. Antibodies and neuronal autoimmune disorders of the CNS. J Neurol. 2010;257:509.