Limbic encephalitis from small-cell lung cancer — SCE Neurology MCQ

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ModerateNeuro-oncologyLimbic encephalitis from small-cell lung cancerSCE Neurology

A 42-year-old man presented with subacute memory loss, seizures and hyponatraemia in a smoker. On examination, there was confusion and emotional lability. Initial investigations showed: MRI showed mesial temporal signal; anti-Hu antibodies were positive. What is the most likely diagnosis?

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Correct answer: B — Limbic encephalitis from small-cell lung cancer

Limbic encephalitis from small-cell lung cancer is the best answer because the vignette describes Limbic encephalitis from small-cell lung cancer: limbic syndrome with anti-Hu suggests paraneoplastic limbic encephalitis. Low-grade glioma is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Glioblastoma and Leptomeningeal carcinomatosis are less appropriate because they would require different localisation, timing or test findings; Paraneoplastic cerebellar degeneration would fit a different syndrome. Clinical pearl: Alzheimer disease is chronic and non-inflammatory.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance