Common differential diagnoses of paraneoplastic encephalitis
| Common aetiologies in differential diagnosis of PNS Vascular Percheron artery occlusion Infectious HSV-1 VZV HHV-6 Whipple disease Listeria meningitis Tuberculous meningitis Creutzfeld-Jakob disease Neurosyphilis Toxic-metabolic Uraemic encephalopathy Hepatic encephalopathy Septic encephalopathy Wernicke-Korsakoff encephalopathy Cancer and cancer therapy related Primary CNS tumours New CNS metastasis or known metastatic progression or leptomeningeal carcinomatosis Complications of cranial radiation therapy (SMART syndrome) Chemotherapy-related encephalopathy | Key differences MRI features/cardiovascular risk factors present Bilateral thalamic T2 FLAIR hyperintensities with diffusion restriction MRI features T2 hyperintense signal on MRI with presence of haemorrhagic necrosis of the affected area Cerebellar oedema Bilateral hyper intensity of hippocampus regions Bilateral hyper intensity of hippocampus regions Contrast enhancing ring lesions in the brainstem Diffuse basal enhancement with enhancing exudates, hydrocephalus DWI basal ganglia or cortical hyperintensities Unilateral/bilateral mesiotemporal FLAIR hyperintensities on MRI. Exclusion with specific testing for syphylis Serum metabolic profile and history are suggestive MRI features Normal or not specific Normal or not specific Wide range of findings from cortical-subcortical haemorrhages, ischaemia, to oedema of the basal ganglia Normal to hyperintense FLAIR fo mammillary bodies MRI features Exclusion with MRI Exclusion with MRI Contrast enhancement of the leptomeninges on MRI Reversible FLAIR cortical hyperintensities with contrast enhancement Various findings depending on the chemotherapeutic agent used and type of encephalopathy |
CNS, central nervous system; HHV-6, human herpes virus-6; HSV-1, herpes simplex virus-1; PNS, paraneoplastic neurological syndromes; SMART, stroke-like migraine attacks after radiation therapy; VZV, varicella zoster virus.