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Paraneoplastic Limbic Encephalitis — RACP Adult Medicine MCQ

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ModerateNeurologyParaneoplastic Limbic EncephalitisRACP Adult Medicine

A 55-year-old man with testicular cancer presents with acute onset psychiatric symptoms (anxiety, hallucinations), seizures, and memory impairment. MRI shows bilateral mesial temporal lobe T2/FLAIR hyperintensity. CSF shows lymphocytic pleocytosis. Anti-NMDA receptor antibodies are negative but anti-Ma2 antibodies are positive. What is the most likely paraneoplastic syndrome?

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Correct answer: C — Limbic encephalitis

Psychiatric symptoms, seizures, memory impairment, and bilateral mesial temporal MRI changes with positive anti-Ma2 antibodies is paraneoplastic limbic encephalitis. Anti-Ma2 is associated with testicular germ cell tumours. Anti-Hu can also cause limbic encephalitis (SCLC). Treatment of the underlying tumour plus immunotherapy (IVIG, plasma exchange, rituximab) may improve outcomes.

Reference: PNS-Care 2024; eTG Neurology 2024