Neurology Resident and Fellow Section

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Neurology Resident and Fellow Section A 53-year-old man with hyperthermia, aphasia and seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette •July 2015: Diagnosis of small cell lung cancer (SCLC; extensive disease with primary brain metastases) •Treatment with carboplatin and etoposide and whole brain irradiation •April 2016: Acute hyperthermia (39 °C), no evidence of infection - Aphasia - Two generalized epileptic seizures Neuhaus, et al. © 2017 American Academy of Neurology

Imaging Figure. Magnetic resonance imaging showing brain metastases, limbic encephalitis, and leptomeningeal carcinomatosis in one patient (A, B) Postcontrast T1-weighted axial MR images showing multiple gadolinium enhancing brain metastases (arrows). (C) Sagittal fluid-attenuated inversion recovery (FLAIR) image; arrows show hyperintense lesions at the mesiotemporal cortex and other parts of the limbic system. (D) Axial diffusion-weighted image; arrow shows reduced diffusion at the left periinsular region. Neuhaus, et al. © 2017 American Academy of Neurology

Three complications of small cell lung cancer involving the brain 1. Multiple brain metastases that may cause seizures 2. Putative paraneoplastic limbic encephalitis causing hyperthermia and seizures 3. Leptomeningeal carcinomatosis at the left periinsular region causing aphasia The patient died ten days after this MRI Reference. 1. Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008;7:327–340. Neuhaus, et al. © 2017 American Academy of Neurology