• Višnja Nesek Adam, Hrvoje Budinčević, Viviana Mršić, Elvira Grizelj Stojčić, Martina Matolić, and Ana Markić.
• University Department of Anaesthesiology, Resuscitation and Intensive Care, Sveti Duh Clinical Hospital, HR-10000 Zagreb, Croatia. Electronic address: visnja.nesek@hotmail.com.
• J Clin Anesth. 2013 Sep 1; 25 (6): 491-5.

AbstractParaneoplastic limbic encephalitis is a rare clinical entity characterized by the development of neuropsychiatric symptoms associated with malignancies. A case of a woman who presented to the Emergency Department with abdominal pain, hyperglycemia, and altered mental status is presented. After initial stabilization and correction of hyperglycemia the patient underwent emergency surgery. Laparotomy showed marked dilatation and gangrenous changes of the colon and tumor in the sigmoid colon. She was mechanically ventilated and remained ventilator-dependent for 42 days. Most of the time she was febrile; fever persisted with peaks up to 40° C despite various antibiotic treatments. On neurological examination, the patient was somnolent with left-sided hemiparesis. Magnetic resonance imaging (MRI) showed hyperintensities in both hippocampal areas, and electroencephalography (EEG) showed sharp-wave activity in the temporal lobes. Cerebrospinal fluid (CSF) examination showed slightly elevated protein levels, and laboratory assessments showed an elevated titer of anti-Yo antibodies. Although we do not have pathological confirmation of limbic encephalitis, the diagnosis of paraneoplastic limbic encephalitis was presumed on the basis of MRI findings, EEG abnormality, elevated CSF protein, positive anti YO antibodies, and neurological findings. © 2013 Elsevier Inc. All rights reserved.

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