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[Glioblastoma multiforme mimicking limbic encephalitis]

Joana Nunes1, Sílvia Carvalho, Paula Gouveia

  • 1Serviço de Neurorradiologia, Centro Hospitalar de Coimbra, Coimbra, Portugal.

Acta Medica Portuguesa
|November 27, 2012
PubMed

Insights

This study presents a rare case of glioblastoma multiforme selectively invading the bilateral limbic system, initially mimicking limbic encephalitis. This rare presentation highlights the importance of considering tumors in differential diagnoses for limbic system dysfunction.

Area of Science:

  • Neuro-oncology
  • Neuropathology
  • Neuroradiology

Background:

  • Gliomas rarely involve the limbic system bilaterally and selectively.
  • Limbic system dysfunction can present with symptoms like memory loss.
  • Differentiating neoplastic from inflammatory processes in the limbic system can be challenging.

Observation:

  • A 58-year-old male presented with acute short-term memory loss.
  • Initial MRI showed bilateral limbic system abnormalities (hippocampus, amygdala, parahippocampus, fornix) with right mesial temporal contrast enhancement.
  • Initial diagnosis of limbic encephalitis was made, and steroid therapy was initiated.

Findings:

  • Follow-up imaging revealed a tumor consistent with glioblastoma multiforme.
  • Neuropathologic examination confirmed glioblastoma multiforme in the right temporal lesion.
  • Glioblastoma's ability to spread via white matter tracts, including the corpus callosum, is known, but selective bilateral limbic invasion is uncommon.

Implications:

  • Selective bilateral limbic system gliomas are rare and can mimic limbic encephalitis.
  • This case underscores the need for thorough diagnostic workup in suspected limbic encephalitis, including consideration of neoplastic etiologies.
  • Advanced neuroimaging and neuropathology are crucial for accurate diagnosis and management of limbic system tumors.

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