18

18.2% may present with concurrent temporal epileptiform discharges, as was evident with our patient. in approximately 90.9% of cases, typically presenting with generalised or local and low-amplitude slow-wave activity. 18.2% may present with concurrent temporal epileptiform discharges, as was evident with our patient. In 36.4% of cases, MRI brain scans may show increased signals restricted to the medial temporal lobes, hippocampus and para-hippocampal gyrus on MRI fluid-attenuated inversion recovery (FLAIR) or T2-weighted imaging with one diffusion restriction, though our patient had a normal MRI brain scan. Nonetheless, autoimmune encephalitides in general are uncommon, and it is suggested by Graus that patients should be considered for a diagnosis of autoimmune encephalitis if all three of the following criteria are met: (1) subacute onset (rapid progression 3 months) of working memory deficits (short-term memory loss), altered mental status (defined as decreased or altered level of consciousness, lethargy or personality change) or psychiatric symptoms; (2) at least one of the following features: new focal CNS findings, seizures not explained by a previously known seizure disorder, CSF pleocytosis ( 5 white cell count per mm3), MRI features suggestive of encephalitis (brain MRI hyperintense signal on T2-weighted FLAIR sequences highly restricted to one or both medial temporal lobes (limbic encephalitis), or in multifocal areas involving grey matter, white matter or both, compatible with demyelination or inflammation and (3) reasonable exclusion of alternative causes.12 SCPC is rare at initial diagnosis (2% of cases). SCPC is more likely to emerge in men with previous androgen deprivation therapy for prostate adenocarcinoma and rarely occurs de novo as in our patient.13 It has an aggressive tumour biology that is associated with rapid development of visceral metastases and bulky tumour masses.14 15 SCPC is characterised by small cell neuroendocrine morphology with the secretion of neuroendocrine tumour markers such as neuron-specific enolase and chromogranin A.14 15 These tumours grow independently from the androgen receptor axis and are thus usually resistant to androgen deprivation therapy.14 SCPC has a poor prognosis and most patients are deceased within 1?year.16 The management of GABABR antibody-associated encephalitis is dependent on the prompt management of seizures and other neurological symptoms, and the treatment of underlying malignancies. There are no Acetylcorynoline specific guidelines that determine the optimal choices of antiepileptics for GABABR antibody-associated encephalitis or other paraneoplastic encephalitides, but antiepileptic management should be aggressive.17 Depending on clinical outcomes, most patients will not require long-term antiepileptics.17 Our patient, however, has required multiple antiepileptics and is still having seizures and cognitive impairment. There are no controlled studies relating to optimal use of immunotherapy in patients with GABABR antibody-associated encephalitis though usually the Rabbit Polyclonal to MMP-9 encephalitis responds Acetylcorynoline well to treatment.7 Overall treatment response is based on clinical evaluation as antibody titres often do not correlate with disease activity.18 When treating for SCPC, the National Comprehensive Cancer Network suggests a combination of etoposide with cisplatin or carboplatin in patients with pure small cell carcinoma of the prostate or combination of docetaxel and carboplatin.19 A single-arm phase II study investigated the use of carboplatin plus docetaxel in combination with prednisone in 113 patients with SCPC. After progression on carboplatin plus doctetaxel, patients were treated with cisplatin and etoposide. Median overall survival of Acetylcorynoline the cohort was 16 months (95%?CI 13.6 to 19.0), and the proportion of patients who were progression free after four cycles of carboplatin plus docetaxel and subsequent treatment with cisplatin plus etoposide (N=71) was 65.4% and 33.8%, respectively.19 20 Androgen deprivation is usually ineffective for SCPCs.19 This case highlights.