Article Text

Download PDFPDF
Trismus caused by paraneoplastic brainstem encephalitis
  1. Naveed Malek,
  2. Maxwell Damian
  1. Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
  1. Correspondence to Dr Naveed Malek, Department of Neurology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD, UK; nmalek{at}


We discuss the assessment and differential diagnoses of a middle-aged man who presented with trismus, double vision and behavioural problems. MRI scan of the brain was initially normal, but a month later showed high signal in the hippocampal region on fluid attenuated inversion recovery sequence (FLAIR) imaging. We suspected a paraneoplastic brainstem encephalitis because of his smoking history, rapidly progressive symptoms and abnormal brainstem signs. A positron emission tomography-CT scan identified abnormal subcarinal nodes, shown on biopsy to be metastatic small cell lung cancer. He is currently undergoing treatment with chemotherapy and radiotherapy.

  • paraneoplastic syndrome

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Both authors contributed equally to the writing of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Mike Zandi, London, UK.

Other content recommended for you