Thalamic Degeneration, Dementia, and Seizures

Abstract

ATIENTS harboring malignant neoplasms may develop neurological and endocrinological disorders in the absence of metastases to the nervous system or endocrine glands.1 The resulting clinical syndromes have beenreferred to as the "remote" or "nonmetastatic" effects of malignant tumors. The exact incidence of these complications has not been determined. Croft and Wilkinson2 state that nonmetastatic neurological syndromes develop in 2% to 16% of carcinomas, and of these, 65% are neuromuscular in type. The incidence of neurological involvement is highest with pulmonary malignancies. Although hypotheses implicating infectious, nutritional immunological, metabolic, and toxic factors have been suggested.1,3-7 the precise biological basis of these remote effects has not been determined.We provide here a clinical and anatomical report of a man who presented with dementia, developed inappropriate secretion of the antidiuretic hormone (ADH), and died six months later in status epilepticus. General autopsy revealed a bronchogenic carcinoma which had not metastasized to the nervous system or endocrine glands. The combination of remote neurological and endocrine complications in the same patient is very rare.8·9 Yet this inconstancy is such, As thou too shalt adore; I could not love thee, dear, so much Loved I not honour more.-Richard Lovelace