Midbrain Encephalitis as a Remote Effect of a Malignant Neoplasm

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Abstract
The incidence of paraneoplastic disorders of the nervous system is difficult to estimate, since they may be overlooked because of the severity of the symptoms directly attributable to the underlying neoplasm. Cases with cerebellar degeneration,1 limbic lobe encephalitis,2 neuromyopathy,3-5 encephalomyelitis,6 myasthenic syndrome,7 and opsoclonus8 have been recorded in association with carcinoma. In patients with brainstem involvement, significant changes have been most frequently observed in the medulla and pons.6-11 We studied the clinicopathological aspects of a case with ophthalmoplegia, generalized seizures, and prominent inflammatory changes in the midbrain. REPORT OF A CASE A 42-year-old man complained of diplopia and a seizure. Three months before admission, he had experienced a sense of fatigue of his eyes followed soon by double vision. He tried to compensate for this by closing his left eye and tilting his head. He had been impotent for two months. His