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Abstract Details

Unusual Presentation of Paraneoplastic Limbic-Encephalitis (PLE) with Acute Retrograde-Amnesia as Presenting Symptom.
Autoimmune Neurology
P11 - Poster Session 11 (11:45 AM-12:45 PM)
53-year-old female history of breast cancer, active neuroendocrine lung cancer metastasis to bone s/p 2-cycles chemotherapy (carboplatin/etoposide/atezolizumab) presents with acute onset memory-loss. She awoke, difficulty remembering events of past 1-year. Denied other symptoms. Her exam, vital-signs, labs (CBC/BMP/B12/B6/B1/thyroid panel) and EEG were unremarkable. She was able to form new memories but her retrograde-amnesia continued >24hrs. MRI: questionable T2/FLAIR hyperintense signal, right temporal-lobe. LP: normal opening-pressure, elevated WBC-20 and protein-123, normal glucose. Meningoencephalitis panel:negative. 2-days following presentation she developed seizures and CI. Repeat EEG: multifocal sharp-spike waves with epileptiform discharges. Antiepileptics were initiated. Acyclovir started prophylactically and Low-dose Solumedrol for suspicion of check point inhibitor induced versus autoimmune versus PLE. There was mild improvement. Repeat LP: improvement in WBC-14 and Protein-75. A review of paraneoplastic Ab-panel from previous LP: high ANNA-1 titer (1:64). Repeat MRI: multifocal hyperintensities. Discontinued acyclovir and started IVIG. Her mentation/amnesia improved.
Paraneoplastic Neurologic syndromes are immune-mediated attacks, accosted with systemic cancer, that attack neuronal tissues evolving over days-weeks causing constellation of neurological symptoms. One such rare syndrome is PLE which usually presents with seizures, Limb-paresis, Cognitive Impairment (CI) and/or psychiatric disturbances. We report a case of a female who presents only with acute onset of memory loss mimicking transient global-amnesia (TGA).
PLE is a rare and devastating disorder that evolve over days-weeks presenting as constellation of neurological symptoms. Here we present a case to exemplify acute presentation with abrupt onset of amnesia and no other symptom. TGA was ruled-out, given Retrograde>anterograde amnesia for >24hrs. Initial workup including MRI/EEG/initial CSF labs were inconclusive. Steroids were delayed due to higher-likelihood of an infectious cause. Pending CSF Autoimmune-labs later revealed presence of ANNA-1 (Anti-Hu). This highlights importance of considering PLE in patients with underlying small-cell lung cancer and progressive neurological symptoms in order to prevent delay of treatment.
Madiha Tariq, MD (Quinte Health Belleville General Hospital)
Dr. Tariq has received personal compensation for serving as an employee of SIU .
Barbara O'Brien, MD (MD Anderson Cancer Center) Dr. O'Brien has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PlusTherapeutics.