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Bilateral temporal glioma presenting as a paraneoplastic limbic encephalitis with pure cognitive impairment

Vincent Deramecourt1, Stéphanie Bombois, Stéphanie Debette

  • 1Department of Neurology and Memory Clinic, University Hospital of Lille and Lille II University, France. v-deramecourt@chru-lille.fr

The Neurologist
|July 11, 2009
PubMed
Abstract

Insights

Bilateral hippocampal primitive brain tumors can cause memory loss, mimicking paraneoplastic limbic encephalitis (PLE). Gliomatosis cerebri should be considered in such cases, even with negative antibody tests.

Area of Science:

  • Neuroscience
  • Oncology
  • Radiology

Background:

  • Memory impairment from bilateral hippocampal tumors is rare.
  • Distinguishing these tumors from paraneoplastic limbic encephalitis (PLE) on MRI can be challenging.
  • PLE mimics suggest autoimmune or neoplastic processes affecting the limbic system.

Observation:

  • A 42-year-old woman presented with amnesia and bilateral limbic hyperintensities on MRI.
  • Initial investigations for PLE were negative, including antibody testing and cancer screening.
  • Progressive memory decline and new MRI findings led to surgical intervention.

Findings:

  • Neuropathology revealed gliomatosis cerebri with a focal high-grade astrocytoma.
  • The tumor infiltrated the hippocampus, causing the observed memory deficits.
  • Initial presentation mimicked inflammatory or autoimmune limbic encephalitis.

Implications:

  • This case underscores the importance of considering infiltrative gliomatosis cerebri.
  • Early recognition of atypical presentations is crucial for accurate diagnosis and treatment.
  • Differential diagnosis in limbic encephalitis requires a broad perspective, including neoplastic etiologies.

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