Paraneoplastic Limbic Encephalitis

56-year-old female with a remote history of endometrial cancer who presented to the hospital with altered mental status and new seizures. There are several regions of increased T2/FLAIR hyperintense signal within the insular/subinsular regions, right greater than left, right frontal opercula, superior right temporal gyrus, right gyrus rectus and bilateral mesial temporal lobes. There was no suspicious postcontrast enhancement, diffusion restriction, or evidence of focal hemorrhage. This is a case of paraneoplastic associated limbic encephalitis. Paraneoplastic limbic encephalitis occurs in <1% of patients with systemic cancers. Small cell lung carcinoma is the most commonly associated tumor. The differential includes herpes encephalitis, low-grade diffuse astrocytoma, status epilepticus and gliomatosis cerebri.