A 62-year-old male, former smoker with no other relevant background, was admitted to the ICU of our center for seizure status.
According to his family, in the last weeks he was irritable and with child behavior, besides having complained in the last days of heaviness and numbness in right limbs.
Crises are controlled with i.v. phenytoin.
There were no remarkable findings in the emergency tests (analytical, ECG, brain CT), except for right basal atelectasis in the chest X-ray.
A lumbar puncture was performed which showed acellular CSF but with hyperproteinorrhachia (72 mg/dl protein) and EEG with left temporal irritative activity.
A brain MRI study showed a hyperintense lesion on the left temporal lobe (FLAIR sequences and diffusion), which did not change after administration of paramagnetic contrast in hemorrhage, nor did it present foci of hemorrhage.
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Treatment with phenytoin was prescribed, consisting of antiretroviral therapy (waiting PCR for herpes simplex) and antibiotics (pneumonia) with Tazocel and Teicoplanin.
She did not present seizures again and remained afflicted with mental illness.
On admission there are no remarkable findings in the physical examination and in the neurological examination he is conscious, with nominal dysphasia, ill-defined mood, attention deficit and tendency to fabular and mild right hemiparesis.
In the following days, paresis and language became normalized; however, the patient died and Korsakoff syndrome persisted.
C-reactive protein (CRP) was completed on the sixth day and antibiotic therapy was negative.
Analytical studies were irrelevant except for mild elevation of CEA (3.9 ng/ml).
Anti-Hu antibodies, antithyroid drugs, serology (lues, HIV, neurotropic virus) were negative.
A screening of occult neoplasia was initiated, starting with TAC (mm. except for atelectasis/pneumonia LDI), urologic bone marrow examination with bronchoalveolar lavage (negative), upper endoscopy and intestinal biopsy, intestinal transit,
Given the normality of these studies, and with the diagnosis of PLE, a whole-body pathology was requested, which showed the presence of hypercaptation of fluoroglucose at the pharyngolaryngeal satellite level, as well as small lymph nodes.
A CT scan of the neck confirmed the diagnosis of squamous cell carcinoma of the pyriform sinus and the pathological study of the lesion was performed.
