B80-5-47 Aphasia Secondary to Hypercalcemia as Presentation of Stage IV Bronchogenic Carcinoma

Abstract Introduction Paraneoplastic syndromes of bronchogenic carcinomas can commonly lead to hypercalcemia. Symptoms range from “stones, bones, groans, psychiatric overtones” to more significant global phenomena such as coma. Focal aphasia is a rare but clinically significant phenomenon which may mimic a cerebrovascular event. Case A 62-year-old woman presented to the ED as a stroke alert for acute change in mentation. An acquaintance reported she was confused before suddenly becoming aphasic. She had a history of unknown cancer and polysubstance use, including opiates. The patient was examined and found to be encephalopathic but followed commands intermittently. She did have complete expressive aphasia. NIHSS in the ED was 7. Her pupils were reactive, non-pinpoint, and had received naloxone per EMS. Stroke imaging studies were all negative. However, a large necrotic mass was visualized in the superior portion of the lung. Lab studies revealed critical hypercalcemia (15.4), mild hyponatremia (132), and mild hypokalemia (3.3). Chest x-ray and CT revealed a necrotic left lung consolidation with mediastinal shift consistent with stage IV bronchogenic carcinoma. Initial treatment consisted of aggressive IV fluid resuscitation and calcitonin administration. CTS was consulted to obtain a tissue diagnosis and hematology/oncology was consulted to assist in staging. As her calcium was corrected over the next 48 hours, the patient’s aphasia began to improve and returned to baseline. General clinical status also improved. The patient was assessed to have appropriate decision-making capacity at this time and elected to enter hospice care and forego aggressive treatment. Discussion This case highlights the importance of considering paraneoplastic hypercalcemia as a reversible cause of aphasia and other neuropsychiatric symptoms. Only a few case reports describe this phenomenon. The symptoms of hypercalcemia are generally well-recognized and documented as global encephalopathy, pain, and even coma. In our patient, reversal of hypercalcemia with IVF and no other significant interventions suggest a causal relationship between the electrolyte abnormality and the focal symptoms in this patient. Paraneoplastic syndrome and an underlying thoracic malignancy is an important differential in otherwise unexplained aphasia. This abstract is funded by: None