Hypermetabolism of the Medial Temporal Lobe in Limbic Encephalitis on &lt;sup&gt;18&lt;/sup&gt;FDG-PET Scan: A Case Report

Na, Duk L.; Hahm, Dong Seok; Park, Sungha; Kim, Sang Eun

doi:10.1159/000052123

Cited by 15 publications

(9 citation statements)

References 7 publications

(9 reference statements)

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“…In addition, patients with serial FDG‐PET imaging showed resolution of hypermetabolism in conjunction with resolution of symptoms, without intervening therapy other than AEDs. Focal hypermetabolism has been reported in cases of suspected encephalitis (Lee et al, 2004), limbic encephalitis (Provenzale et al, 1998; Fakhoury et al, 1999; Kassubek et al, 2001; Na et al, 2001; Fauser et al, 2005), Landau‐Kleffner syndrome (Luat et al, 2006), and the syndrome of continuous spike‐and‐wave activity during slow‐wave sleep (Luat et al, 2005). The reports noted previously could not exclude the possibility that hypermetabolism was ictal.…”

Section: Discussionmentioning

confidence: 99%

Aphasic or amnesic status epilepticus detected on PET but not EEG

Dong¹,

Subramaniam²,

Delbeke

et al. 2009

Epilepsia

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Summary Purpose: To describe five patients with ictal aphasia and one patient with ictal amnesia, who had focal positron emission tomography (PET) hypermetabolism but no clear ictal activity on electroencephalography (EEG). Methods: 18F‐Fluorodeoxyglucose (FDG)–PET scans with concomitant EEG were obtained in five patients with suspected ictal aphasia or ictal amnesia without ictal activity on EEG. We reviewed medical history, EEG, imaging data, and treatment outcome. Results: Brain magnetic resonance imaging (MRI) showed no structural abnormalities in any of the patients. EEG showed left temporal irregular delta activity in three patients, with aphasia and nonspecific abnormalities in two other patients, all without clear ictal pattern. All patients demonstrated focal hypermetabolism on PET scan. The hypermetabolism was in the left frontotemporal region in patients with ictal aphasia and in the bilateral hippocampal region in the patient with amnesia. Three patients who received intravenous benzodiazepines during their episodes had transient clinical improvement. With antiepileptic drug (AED) treatment, symptoms gradually resolved in all patients. Concomitant resolution of PET hypermetabolism was documented in three patients who had follow up scans. One patient with ictal aphasia later developed recurrent episodes, each with recurrent PET hypermetabolism. This patient and one other patient required immune‐modulating therapy in addition to AEDs. Discussion: FDG‐PET imaging should be considered as a diagnostic tool in patients with suspected ictal aphasia or amnesia, who fail to show clear evidence of ictal activity on EEG.

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Section: Discussionmentioning

confidence: 99%

Aphasic or amnesic status epilepticus detected on PET but not EEG

Dong¹,

Subramaniam²,

Delbeke

et al. 2009

Epilepsia

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“…It may detect the occult malignancy or assess the extent of the functional abnormality in the brain and its response to treatment [33,34,35]. In most cases of paraneoplastic limbic encephalitis, 18 F-FDG PET usually shows hypermetabolism in the temporal lobes [36,37,38] with negative findings on MRI, or presence of T 2 -hyperintense mesiotemporal lesions [39,40,41]. Investigation of case studies with cerebellar degeneration has demonstrated cerebellar hypermetabolism on brain 18 F-FDG PET scan in untreated patients, which was reduced after treatment [42,43].…”

Section: Pet Imagingmentioning

confidence: 99%

Paraneoplastic Neurological Syndromes and the Role of PET Imaging

2010

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Paraneoplastic neurological syndromes are immune-mediated effects of cancer that involve the nervous system and are associated with various anti-neuronal antibodies. They can be associated with several cancers such as lung, gynecologic, thymic, testicular and others, but the diagnosis of cancer often becomes a challenge, since paraneoplastic neurological syndromes usually precede the cancer presentation by months or even years. Furthermore, even when the cancer develops, the tumor size remains small and usually undetectable by conventional diagnostic tests and imaging. Positron emission tomography imaging may be an adjunct to timely diagnosis of the occult malignancy in order to employ the specific cancer treatment. Furthermore, positron emission tomography can assess the extent of the functional abnormality in the brain and monitor its response to treatment.

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“…Functional cerebral imaging (SPECT or FDG-PET) is the most sensitive radiological examination in the diagnosis of LE allowing to highlight signs of hypermetabolism in the temporal and extratemporal regions (Franck et al, 1987;Provenzale, Barboriak, & Coleman, 1998;Fakhoury, Abou-Khalil, Kessler, 1999;Na, Hahm, Park, & Kim, 2001;Kassubek et al, 2006). This examination was not performed in our study because it is not available in our hospital, and its practice was not indispensable because all patients had positive brain MRI.…”

Section: Discussionmentioning

confidence: 99%

Limbic encephalitis: Experience of a moroccan center

et al. 2018

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ObjectivesHistologically defined as an inflammation—degeneration of limbic structures, limbic encephalitis (LE) is a rare disease and often difficult to diagnose particularly in institutions with limited access to laboratory tests such as antineuronal antibodies or HSV‐PCR, and functional imaging. We aimed to describe the demographic, clinical, paraclinical, and etiological features of LE, as well as its medium‐term prognosis in Moroccan patients.Materials and MethodsWe collected retrospectively all patients diagnosed with LE in the Department of Neurology of the University Hospital Hassan II of Fez (Morocco) between September 2008 and December 2016. We analyzed their demographic features, clinical manifestations, magnetic resonance imaging and laboratory findings, etiologies, and medium‐term prognoses.ResultsWe included 22 men and 9 women aged 14–76 years (mean age: 45.8 years). In 64.5% of cases, the onset of symptoms was acute. The clinical manifestations included generalized status epilepticus (16.1%), confusional syndrome (29%), epileptic seizures (38.7%), psychiatric disorders (48.4%), and memory disorders (45.2%). The nonlimbic symptoms were nuchal stiffness (22.6%), headaches (9.7%), fever (61.3%), vesicular rash (3.2%), and language disorders (6.5%). The different etiologies found were herpes simplex virus (6.5%), syphilis (16.1%), tuberculosis (3.2%), varicella (3.2%), paraneoplastic autoimmune LE (22.6%), anti‐NMDA‐R LE (6.5%), and sarcoidosis (3.2%). We found 12 cases (38.7%) of LE without definite etiology and with an incomplete diagnostic workup. The medium‐term clinical course includes a complete remission in 45.2% of cases and partial remission in 45.1% of cases. The different sequelae were temporal lobe epilepsy (9.7%), anterograde amnesia (16.1%), and severe cognitive impairment (19.4%). The mortality rate was 9.7% (3 patients).ConclusionOur study shows a wide diversity of etiologies of LE in Morocco with essentially an acute mode of onset of symptoms.

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Hypermetabolism of the Medial Temporal Lobe in Limbic Encephalitis on <sup>18</sup>FDG-PET Scan: A Case Report

Cited by 15 publications

References 7 publications

Aphasic or amnesic status epilepticus detected on PET but not EEG

Aphasic or amnesic status epilepticus detected on PET but not EEG

Paraneoplastic Neurological Syndromes and the Role of PET Imaging

Limbic encephalitis: Experience of a moroccan center

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