Neuropsychiatric findings in anti-Ma2-positive paraneoplastic limbic encephalitis

Abstract

In 1999, a novel paraneoplastic entity in patients with testicular cancer, paraneoplastic limbic encephalitis (PLE), and antibodies against Ma2 was reported.1 We describe a man with anti-Ma2-positive PLE in metastasized testicular cancer. In the summer of 1999, a 39-year-old previously healthy man developed obsessive doubts that his central heating was leaking water. He started to check the equipment >10 times/day. Additional rituals of checking lights, doors, and windows developed. In December 1999, obsessive–compulsive disorder (OCD) was diagnosed. In January 2000, the patient noticed a lump in his right testicle. Orchiectomy and retroperitoneal lymph dissection followed. The histologic examination showed a differentiated nonmetastasized teratoma and a seminoma-in-situ. In August 2000, a first generalized seizure occurred. Since June 2001, memory deficits, gustatory sensory auras, and moderate chronic daily headache were reported. We saw the patient in November 2001, when tests on verbal memory confirmed serious deficits in learning and recognizing new information, especially during delayed recall. Episodic and semantic knowledge decreased in accordance with a temporal gradient. Repeated MRI showed a nonenhancing T2-hyperintense signal change in the left hippocampus. Scalp EEG inconstantly showed left temporal sharp slow-wave activity. …