PMID- 12833885
OWN - NLM
STAT- MEDLINE
DCOM- 20030902
LR  - 20070222
IS  - 0006-8969 (Print)
IS  - 0006-8969 (Linking)
VI  - 55
IP  - 5
DP  - 2003 May
TI  - [An autopsy case of encephalopathy associated with small cell carcinoma of the 
      stomach with nonconvulsive status epilepticus resembling Creutzfeldt-Jakob 
      disease].
PG  - 423-8
AB  - A 64-year-old man developed progressive dementia and altered consciousness with 
      myoclonus over 2 months. Neurological examination revealed mild dysphagia and 
      negative myoclonus of both hands. Electroencephalography (EEG) showed continuous 
      periodic synchronous discharge (PSD) of 1 Hz, although his EEG abnormality was 
      not similar to that usually observed in Creutzfeldt-Jakob disease (CJD). Magnetic 
      resonance imaging (MRI) of the brain revealed only few lacunes. Laboratory data 
      were also normal. Since his consciousness level fluctuated and the PSD were 
      spiky, we came to a diagnosis of nonconvulsive status epilepticus (NCSE). After 
      administering the valproic acid, his symptoms and EEG finding improved. Nine 
      months after the onset, despite his continued valproic acid, the patient had 
      recurrent NCSE and PSD of 1 Hz. Diffusion-weighted MRI showed a T2-hyperintense 
      lesion in the right parietal lobe, where SPECT scans showed hyperperfusion. After 
      adding zonisamide, he improved slowly. The follow-up MRI and SPECT showed a 
      disappearance of the previous lesion. Now CT scans of the abdomen showed enlarged 
      periaortic lymph node and endoscopic ultrasonography disclosed a submucosal tumor 
      of the stomach. Biopsy of the periaortic lymph node by laparotomy revealed 
      undifferentiated adenocarcinoma with its origin being unclear. Chemotherapy 
      didn't work well for the tumor and the patient underwent a downhill course, 
      although his mental and neurological manifestation were mostly unremarkable. Two 
      years and four months after the onset, he died in emaciation. Autopsy confirmed 
      small cell carcinoma originating in the stomach and metastases in the liver and 
      lungs. Neuropathological examination revealed only mild scattered gliosis. This 
      case was unique in the prolonged CJD-like manifestations, which turned out to be 
      due to NCSE. Despite anti-neuronal antibodies were not detected, we suspect yet 
      another paraneoplastic brain syndrome in this patient.
FAU - Wada, Yuko
AU  - Wada Y
AD  - Department of Neurology, Osaka Saiseikai Nakatsu Hosipital, Japan.
FAU - Yamamoto, Toru
AU  - Yamamoto T
FAU - Kita, Yasushi
AU  - Kita Y
FAU - Fukunishi, Shinya
AU  - Fukunishi S
FAU - Ashida, Kiyoshi
AU  - Ashida K
LA  - jpn
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - No To Shinkei
JT  - No to shinkei = Brain and nerve
JID - 0413550
SB  - IM
MH  - Aged
MH  - Brain Diseases/diagnosis/*pathology
MH  - Carcinoma, Small Cell/*complications
MH  - Creutzfeldt-Jakob Syndrome/*diagnosis
MH  - Diagnosis, Differential
MH  - Diffusion Magnetic Resonance Imaging
MH  - Electroencephalography
MH  - Humans
MH  - Male
MH  - Status Epilepticus/*diagnosis
MH  - Stomach Neoplasms/*complications
EDAT- 2003/07/02 05:00
MHDA- 2003/09/03 05:00
CRDT- 2003/07/02 05:00
PHST- 2003/07/02 05:00 [pubmed]
PHST- 2003/09/03 05:00 [medline]
PHST- 2003/07/02 05:00 [entrez]
PST - ppublish
SO  - No To Shinkei. 2003 May;55(5):423-8.