Teaching NeuroImages: Three complications of small-cell lung cancer involving the brain

A 53-year-old man with small-cell lung cancer (SCLC) with brain metastases presented with acute hyperthermia (up to 39°C) without evidence of infection, aphasia, and 2 generalized epileptic seizures. MRI made 3 brain complications of SCLC visible. First, multiple brain metastases (figure, A and B) were noted. Second, hyperintense areas at the limbic system (figure, C) were present, favoring a diagnosis of paraneoplastic limbic encephalitis, although associated antibodies were negative. Limbic encephalitis can cause both hyperthermia and seizures.1 Third, aphasia was explained by a region of reduced diffusion at the left insula (figure, D). Consistently, CSF analysis confirmed leptomeningeal carcinomatosis.
Source: Neurology - Category: Neurology Authors: Tags: Metastatic tumor, Paraneoplastic syndrome RESIDENT AND FELLOW SECTION Source Type: research