Abstract
Limbic encephalitis as a distinct clinicopathological entity is becoming increasingly familiar to neurologists. However, despite its classical clinical presentation of mental status changes and behavioral abnormalities, the disorder is not well known in the psychiatric literature and premortem diagnosis is rare. We recently participated in the care of a patient who spent two months on a psychiatric service and in whom a medical disorder was consistently suspected but not confirmed until autopsy revealed paraneoplasic limbic encephalitis and two primary systemic malignancies. A detailed neuropsychiatric description of this clinical entity is provided from presentation to autopsy with review of the literature.
References
- Amsterdam J.D., Winokur A., Dyson W. Borna virus disease. A possible etiologic factor in human affective disorders? Arch Gen Psychiatry. 1985;42:1093–1096. doi: 10.1001/archpsyc.1985.01790340077011. [DOI] [PubMed] [Google Scholar]
- Anderson N., Posner J.B. Remote effects of cancer on the nervous system (paraneoplastic syndrome) Neuro View. 1987;3:6–16. [Google Scholar]
- Bartrop R.W., Lazarus L., Luckhurst E., Lazarus L. Depressed lymphocyte function after bereavement. Lancet. 1977;1:834–836. doi: 10.1016/s0140-6736(77)92780-5. [DOI] [PubMed] [Google Scholar]
- Brennan L.V., Craddock P.R. Limbic encephalopathy as a nonmetastatic complication of oat cell cancer. Its reversal after treatment of the primary lung lesion. Am J Med. 1983;75:518–520. doi: 10.1016/0002-9343(83)90358-3. [DOI] [PubMed] [Google Scholar]
- Brierly J.B., Corsellis J.A.N., Hierons R. Subacute encephalitis of later adult life mainly affecting the limbic areas. Brain. 1960;83:356–368. [Google Scholar]
- Broca P. Sur la préparation des hémìsphères cérébraux. Rev Anthropol. 1878;7:385–498. [Google Scholar]
- Camara E.G., Chelune G.H. Paraneoplastic limbic encephalopathy. Brain Behav Immun. 1987;1:349–355. doi: 10.1016/0889-1591(87)90038-9. [DOI] [PubMed] [Google Scholar]
- Carr I. The Ophelia syndrome: Memory loss in Hodgkin's disease. Lancet. 1982;1:844–845. doi: 10.1016/s0140-6736(82)91887-6. [DOI] [PubMed] [Google Scholar]
- Cornelius J.R., Soloff P.M., Miewald B.K. Behavioral manifestations of paraneoplastic encephalopathy. Biol Psychiatry. 1986;21:686–690. doi: 10.1016/0006-3223(86)90131-9. [DOI] [PubMed] [Google Scholar]
- Corsellis J.A.N., Goldberg G.J., Norton A.R. Limbic encephalitis and its association with carcinoma. Brain. 1968;91:481–496. doi: 10.1093/brain/91.3.481. [DOI] [PubMed] [Google Scholar]
- Daniel S.E., Love S., Scaravilli F., Harding A.E. Encephalomyeloneuropathy in the absence of a detectable neoplasm. Acta Neuropathol. 1985;66:311–317. doi: 10.1007/BF00690964. (Berl) [DOI] [PubMed] [Google Scholar]
- Delsedime M., Cantello R., Durelli L. A syndrome resembling limbic encephalitis, associated with bronchial carcinoma, but without neuropathological abnormality: A case report. J Neurol. 1984;231:165–166. doi: 10.1007/BF00313687. [DOI] [PubMed] [Google Scholar]
- Dorfman L.J., Forno L.S. Paraneoplastic encephalomyelitis. Acta Neurol Scand. 1972;48:556–574. doi: 10.1111/j.1600-0404.1972.tb07576.x. [DOI] [PubMed] [Google Scholar]
- Dubas F., Gray F., Escourolle R. Polioencephalomyelites subaigues avec cancer. Six cas anatomo-cliniques et revue de la literature. Rev Neurol. 1982;138:725–742. [PubMed] [Google Scholar]
- Dubas F., Gray F., Henin D. Polioencephalomyelites subaigues sans cancer. Quatre cas anatomo-cliniques et revue de la literature. Rev Neurol. 1982;138:743–753. [PubMed] [Google Scholar]
- Franck G., Sadzot B., Salmon E. Encephalopathic limbique paraneoplastique secretion inapropriée d'ADM et crises epileptiques subintrantes infracliniques. Rev Neurol. 1987;143:657–669. [PubMed] [Google Scholar]
- Glaser G.H., Pincus J.H. Limbic encephalitis. J Nerv Ment Dis. 1969;149:59–67. doi: 10.1097/00005053-196907000-00009. [DOI] [PubMed] [Google Scholar]
- Graus F., Elkon K.B., Cordon-Cardo C. Sensory neuronopathy and small cell lung cancer. Antineuronal antibody that also reacts with the tumor. Am J Med. 1986;80:45–52. doi: 10.1016/0002-9343(86)90047-1. [DOI] [PubMed] [Google Scholar]
- Greco F.A. Paraneoplastic syndromes. West J Med. 1986;144:604–606. [PMC free article] [PubMed] [Google Scholar]
- Greenlee J.E., Lipton M.L. Anticerebellar antibodies in serum and cerebrospinal fluid of a patient with oat cell carcinoma of the lung and paraneoplastic cerebellar degeneration. Ann Neurol. 1986;19:82–85. doi: 10.1002/ana.410190117. [DOI] [PubMed] [Google Scholar]
- Hall R.C.W., Gardner E.R., Stickney S.K. Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population. Arch Gen Psychiatry. 1980;37:989–995. doi: 10.1001/archpsyc.1980.01780220027002. [DOI] [PubMed] [Google Scholar]
- Hall R.C.W., Popkin M.K., Devaul R.A. Physical illness presenting as psychiatric disease. Arch Gen Psychiatry. 1978;35:1315–1320. doi: 10.1001/archpsyc.1978.01770350041003. [DOI] [PubMed] [Google Scholar]
- Henson R.A., Hoffman H.L., Urich H. Encephalomyelitis with carcinoma. Brain. 1965;88:449–464. doi: 10.1093/brain/88.3.449. [DOI] [PubMed] [Google Scholar]
- Henson R.A., Urich H. Blackwell Scientific Publications; Oxford: 1982. Cancer and the Nervous System; pp. 314–345. [Google Scholar]
- Himmelhoch J., Pincus J., Tucker G. Subacute encephalitis: Behavioral and neurological aspects. Br J Psychiatry. 1970;116:531–538. doi: 10.1192/bjp.116.534.531. [DOI] [PubMed] [Google Scholar]
- Isaacson R.L. ed 2. Plenum Press; New York: 1982. The Limbic System. [Google Scholar]
- Jaeckle K.A., Graus F., Houghton A. Autoimmune response of patients with paraneoplastic cerebellar degeneration to a Purkinje cell cytoplasmic protein antigen. Ann Neurol. 1985;15:592–600. doi: 10.1002/ana.410180513. [DOI] [PubMed] [Google Scholar]
- Jaeckle K.A., Rogers L., Wang M. Autoimmune paraneoplastic limbic encephalitis (Abstract) Neurology. 1988;38(Suppl 1):390. [Google Scholar]
- Janati A., Gray R.P., Souheaver G.T. A mental syndrome associated with colonic carcinoma: Limbic encephalitis? Psychosomatics. 1987;28:48–50. doi: 10.1016/S0033-3182(87)72580-8. [DOI] [PubMed] [Google Scholar]
- Jenicke M.A. PSG Publishing Co Inc; Littleton, MA: 1985. (Handbook of Geriatric Psychopharmacology). [Google Scholar]
- Kaplan A.M., Itabishi H.H. Encephalitis associated with carcinoma. J Neurol Neurosurg Psychiatry. 1974;37:1166–1176. doi: 10.1136/jnnp.37.10.1166. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Koella W.P. The limbic system and behavior. Acta Psychiatr Scand. 1984;313:35–45. doi: 10.1111/j.1600-0447.1984.tb07152.x. (Suppl) [DOI] [PubMed] [Google Scholar]
- Lang B., Newson-Davis J., Wray D. Autoimmune aetiology for myasthenic (Eaton-Lambert) syndrome. Lancet. 1981;2:224–226. doi: 10.1016/s0140-6736(81)90474-8. [DOI] [PubMed] [Google Scholar]
- Langston J.W., Dorfman L.J., Forno L.S. Encephalomyeloneuritis in the absence of cancer. Neurology. 1975;25:633–637. doi: 10.1212/wnl.25.7.633. [DOI] [PubMed] [Google Scholar]
- Lavi E., Fishman P.S., Highkin M.K., Weiss S.R. Limbic encephalitis after inhalation of a murine coronavirus. Lab Invest. 1988;58:31–36. [PubMed] [Google Scholar]
- Levitt P. A monoclonal antibody to limbic system neurons. Science. 1984;223:290–301. doi: 10.1126/science.6199842. [DOI] [PubMed] [Google Scholar]
- Levitt P., Pawlati-Byczkowska E., Morton H.L. Assembly of functional systems in the brain: Molecular and anatomical studies of the limbic system. In: Epstein C.S., editor. The Neurobiology of Down's Syndrome. Raven Press; New York: 1986. pp. 195–209. [Google Scholar]
- Ludwig H., Bode L., Gosztonyi G. Borna disease: A persistent virus infection of the central nervous system. Progr Med Virol. 1988;35:107–151. [PubMed] [Google Scholar]
- Maricle R., Leung P., Bloom J.D. The use of DSM-III axis III in recording physical illness in psychiatric patients. Am J Psychiatry. 1987;144:1484–1486. doi: 10.1176/ajp.144.11.1484. [DOI] [PubMed] [Google Scholar]
- Markman M. Response of paraneoplastic syndromes to antipeoplastic therapy. West J Med. 1986;144:580–585. [PMC free article] [PubMed] [Google Scholar]
- Markman M., Abeloff M.D. Small-cell lung cancer and limbic encephalitis. Ann Int Med. 1982;96:785. doi: 10.7326/0003-4819-96-6-785_1. [DOI] [PubMed] [Google Scholar]
- Mendelsohn J. Principles of neoplasm. In: Braunwald E., editor. Harrison's Principles of Internal Medicine. ed 11. McGraw-Hill; New York: 1987. pp. 421–431. [Google Scholar]
- Narayan O., Herzog S., Scheefers K.H., Rott R. Behavioral disease in rats caused by immunopathological responses to persistent Borna virus in the brain. Science. 1983;220:1401–1403. doi: 10.1126/science.6602380. [DOI] [PubMed] [Google Scholar]
- Palma G. Paraneoplastic syndromes of the nervous system. West J Med. 1985;142:787–796. [PMC free article] [PubMed] [Google Scholar]
- Papez J.W. A proposed mechanism of emotion. Arch Neurol Psychiatry. 1937;38:725–743. [Google Scholar]
- Patchell R.A., Posner J.B. Neurologic complications of systemic cancer. Neurol Clin. 1985;3:729–750. [PubMed] [Google Scholar]
- Richardson E.P. Case records of the Massachusetts General Hospital (Case 30—1985) N Engl J Med. 1985;313:249–257. doi: 10.1056/NEJM198507253130408. [DOI] [PubMed] [Google Scholar]
- Rott R., Herzog S., Fleischer B., Koprowski H. Detection of serum antibodies to Borna disease virus in patients with psychiatric disorders. Science. 1985;22:755–756. doi: 10.1126/science.3922055. [DOI] [PubMed] [Google Scholar]
- Schleifer S.J., Keller S.E., Camerino M. Suppression of lymphocyte stimulation following bereavement. JAMA. 1983;250:374–377. [PubMed] [Google Scholar]
- Sprankel H., Richarz K., Ludwig H., Rott R. Behavioral alterations in tree shrews (Tupaia glis, Diuard 1820) induced by Borna virus. Med Microbiol Immunol. 1978;165:1–18. doi: 10.1007/BF02121228. [DOI] [PubMed] [Google Scholar]
- Stefansson K., Arnason B.G.W. Neurologic manifestations of systemic neoplasma. In: Braunwald E., editor. Harrison's Principles of Internal Medicine. McGraw-Hill; New York: 1987. pp. 1600–1604. [Google Scholar]
- Tandon R., Walden M., Falcon S. Catatonia as a manifestation of paraneoplastic encephalopathy. J Clin Psychiatry. 1988;49:121–122. [PubMed] [Google Scholar]
- Torrey E.F., Peterson M.R. Schizophrenia and the limbic system. Lancet. 1974;2:942–946. doi: 10.1016/s0140-6736(74)91143-x. [DOI] [PubMed] [Google Scholar]