Limbic encephalitis


  • Autoimmune encephalitis caused by autoantibodies against intracellular neuronal proteins
  • Typically not limited to limbic system
  • Majority of cases are paraneoplastic, particularly associated with small cell lung cancer, germ-cell testicular tumors, teratomas

Clinical Features

  • Mimics HSV encephalitis
  • Subacute presentation over days to weeks
  • Short-term memory deficits
  • Headache
  • Irritability, sleep disturbance, agitation
  • Delusions, hallucinations, psychosis
  • Seizure

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma



  • Diagnosis unlikely to be made in the ED
  • Evaluate for alternative diagnoses
  • MRI Brain- usually increased T2 signal involving one or both temporal lobes.[1]
  • LP- CSF w/lymphocytosis (though usually <100), elevated protein, normal glucose, elevated IgG index, oligoclonal bands[2]



  • Admit

See Also


  1. Nicholas, D (2003). "Clinical, Magnetic Resonance Imaging, and 7Electroencephalographic Findings in Paraneoplastic Limbic Encephalitis". Mayo Clinic Proceedings. 78 (11): 1363–1368.
  2. Vincent A, Buckley C, Schott JM, et al. (2004). "Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis". Brain. 127 (3): 701–712
  3. Tüzün E, Dalmau J (2007). Limbic encephalitis and variants: classification, diagnosis and treatment. The Neurologist. 13 (5).
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