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Kitamura W, Ennishi D, Yukawa R, Sasaki R, Yoshida C, Takasuka H, Fujiwara H, Asada N, Nishimori H, Fujii K, Fujii N, Matsuoka KI, Abe K, Yoshino T, Maeda Y. Nodal Peripheral T-cell Lymphoma with T Follicular Helper Phenotype Presenting as Chorea During Treatment: A Case Report and Literature Review. Intern Med 2021; 60:3155-3160. [PMID: 33814503 PMCID: PMC8545639 DOI: 10.2169/internalmedicine.7180-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 11/06/2022] Open
Abstract
A 72-year-old man presented with chorea while undergoing treatment for recurrence of nodal peripheral T-cell lymphoma with T follicular helper (TFH) phenotype. An examination by brain N-isopropyl-p-iodoamphetamine (123I-IMP)-single photon emission computed tomography (SPECT) revealed no abnormalities other than a decreased cerebral blood flow (CBF) in the left striatum. After four courses of salvage chemotherapy, his clinical symptoms and asymmetric cerebral perfusion improved, suggesting that the decreased CBF had caused chorea. The significance of brain SPECT has not been fully clarified in patients with chorea-associated malignant lymphoma, warranting further investigations. Brain SPECT is an alternative approach to identify abnormalities in such patients.
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Affiliation(s)
- Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Daisuke Ennishi
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Japan
| | - Ryoya Yukawa
- Department of Hematology and Oncology, Okayama University Hospital, Japan
- Center for Postgraduate Clinical Training, Okayama University Hospital, Japan
| | - Ryo Sasaki
- Department of Neurology, Okayama University Hospital, Japan
| | | | - Hiroki Takasuka
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Keiko Fujii
- Division of Clinical Laboratory, Okayama University Hospital, Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion, Okayama University Hospital, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Hospital, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Japan
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Patel RA, Hall DA, Eichenseer S, Bailey M. Movement Disorders and Hematologic Diseases. Mov Disord Clin Pract 2021; 8:193-207. [PMID: 33553488 PMCID: PMC7853188 DOI: 10.1002/mdc3.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Movement disorders can be associated with or caused by hematological abnormalities. The objective of this review is to highlight features that will aid in the clinician's recognition and treatment of these disorders. METHODS MESH terms relevant to movement disorders and hematologic diseases were searched to identify conditions included in this narrative, educational review. RESULTS Several conditions were identified, and they were organized by hematologic categories to include red blood cell abnormalities, white blood cell abnormalities, disorders of clotting and bleeding, hematologic malignancies, and others. CONCLUSIONS This review will increase providers' understanding of disorders that include movement disorders and hematologic abnormalities. Basic hematologic laboratories can aid in assessment of these disorders, to include complete blood count/hemogram and peripheral blood smear. Recognition is key, especially in the setting of underlying malignancy, vitamin deficiency, or other disorder in which treatment is available.
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Affiliation(s)
- Roshni Abee Patel
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Deborah A. Hall
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Sheila Eichenseer
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Meagan Bailey
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
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Movement disorders in primary central nervous system lymphoma: two unreported cases and a review of literature. Neurol Sci 2021; 42:905-910. [PMID: 33443666 DOI: 10.1007/s10072-020-04985-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recognition of secondary movement disorders (SMDs) is fundamental either to alleviate disabling disturbances or to treat potentially life-threatening conditions, such as brain tumors. Primary CNS lymphoma (PCNSL) is a rare form of CNS cancer that is often located in subcortical areas, accounting for both neuropsychiatric and motoric disorders. Nevertheless, an overview on PCNSL-related movement disorders (MDs) phenomenology has not been provided yet. OBJECTIVE To outline the main features of PCNSL-related MDs. METHODS A retrospective analysis was conducted on a cohort of patients with PCNSL presenting with MDs, including all existing cases identified by a systematic literature review (source: Medline; period: 1946-2020) and two unreported cases. Data on phenomenology, neuroimaging, histology, and clinical course were collected. RESULTS A total cohort of fifteen subjects was defined, enrolling thirteen previously described patients extracted from eleven published studies, and our two unreported cases. A parkinsonian syndrome appearing at about 60 years of age, unresponsive to levodopa, associated to other neurological signs, resulted as the most common presentation of PCNSL-related MD. Chorea, dystonia, and dyskinesia occurred less frequently, with some degree of responsiveness to symptomatic treatments. Basal ganglia were involved in most cases and motoric disturbances often ameliorated after tumor mass reduction. CONCLUSIONS This study identified those features of PCNSL-related MDs that could support an appropriate approach to such a rare condition. In fact, while the outcome remains still poor, the therapeutic scenario of PCNSL is changing; an early diagnosis together with an adequate management will be thus crucial for timely and successful interventions.
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Nagarajan E, Yerram SY, Digala LP, Bollu PC. Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein. J Neurosci Rural Pract 2020; 11:492-494. [PMID: 32753821 PMCID: PMC7394633 DOI: 10.1055/s-0040-1713300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14–3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.
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Affiliation(s)
- Elanagan Nagarajan
- Department of Neurology, Columbia University, New York, New York, United States
| | - Sushma Y Yerram
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Lakshmi P Digala
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
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EMG activity and neuronal activity in the internal globus pallidus (GPi) and their interaction are different between hemiballismus and apomorphine induced dyskinesias of Parkinson's disease (AID). Brain Res 2015; 1603:50-64. [PMID: 25656789 DOI: 10.1016/j.brainres.2015.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/17/2015] [Accepted: 01/26/2015] [Indexed: 11/24/2022]
Abstract
The nature of electromyogram (EMG) activity and its relationship to neuronal activity in the internal globus pallidus (GPi) have not previously been studied in hyperkinetic movement disorders. We now test the hypothesis that GPi spike trains are cross-correlated with EMG activity during apomorphine-induced dyskinesias of Parkinson's disease (AID), and Hemiballism. We have recorded these two signals during awake stereotactic pallidal surgeries and analyzed them by cross-correlation of the raw signals and of peaks of activity occurring in those signals. EMG signals in Hemiballism usually consist of 'sharp' activity characterized by peaks of activity with low levels of activity between peaks, and by co-contraction between antagonistic muscles. Less commonly, EMG in Hemiballism shows 'non-sharp' EMG activity with substantial EMG activity between peaks; 'non-sharp' EMG activity is more common in AID. Therefore, these hyperkinetic disorders show substantial differences in peripheral (EMG) activity, although both kinds of activity can occur in both disorders. Since GPi spike×EMG spectral and time domain functions demonstrated inconsistent cross-correlation in both disorders, we studied peaks of activity in GPi neuronal and in EMG signals. The peaks of GPi activity commonly show prolonged cross-correlation with peaks of EMG activity, which suggests that GPi peaks are related to the occurrence of EMG peaks, perhaps by transmission of GPi activity to the periphery. In Hemiballism, the presence of direct GPi peak×EMG peak cross-correlations at the site where lesions relieve these disorders is evidence that gradual changes in peak GPi neuronal activity are directly involved in Hemiballism.
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Noda K, Hattori N, Okuma Y. Primary central nervous system lymphoma presenting as choreoathetosis. BMJ Case Rep 2014; 2014:bcr-2013-203353. [PMID: 24739655 DOI: 10.1136/bcr-2013-203353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kazuyuki Noda
- Department of Neurology, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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Abstract
Chorea is one of the major types of involuntary movement disorders originating from dysfunctional neuronal networks interconnecting the basal ganglia and frontal cortical motor areas. The syndrome is characterised by a continuous flow of random, brief, involuntary muscle contractions and can result from a wide variety of causes. Diagnostic work-up can be straightforward in patients with a positive family history of Huntington's disease or acute-onset hemichorea in patients with lacunar stroke, but it can be a challenging and complex task in rare autoimmune or genetic choreas. Principles of management focus on establishing an aetiological classification and, if possible, removal of the cause. Preventive strategies may be possible in Huntington's disease where genetic counselling plays a major part. In this review we summarise the current understanding of the neuroanatomy and pathophysiology of chorea, its major aetiological classes, and principles of diagnostic work-up and management.
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Holl A, Feichtinger M, Körner E, Stefan H, Ott E. Ictal dystonic posturing in mesial versus neocortical temporal lobe seizures. Seizure 2005; 14:269-73. [PMID: 15911362 DOI: 10.1016/j.seizure.2005.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 03/11/2005] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Ictal contralateral dystonic posturing is a frequently observed clinical feature in temporal lobe seizures. It is generally interpreted as the result of spread of the ictal discharge into basal ganglia structure. In previous reports, analysing ictal behavior, a precise definition and description of the upper limb ictal dystonia is often lacking or contradictory. In our study we aimed to determine whether different subtypes of dystonia and their latency from the clinical onset of seizure might be of value for the differentiation between mesial temporal lobe epilepsy (MTLE) and neocortical temporal lobe epilepsy (NTLE). METHODS Eighty seizures (51 MTLE and 29 NTLE) and 30 patients (20 MTLE and 10 NTLE) were analyzed with regard to dystonic posturing of the upper limb. Ictal dystonia was subdivided into different subtypes according to distinct clinical features. Their frequency and latency from the clinical onset of seizure were assessed. RESULTS Frequencies of all subtypes were similar in MTLE and NTLE. Concerning the latencies contralateral dystonic posturing characterized by sustained muscle contractions with flexion of the wrist and fist closure, a frequently appearing feature, occurred significantly earlier in NTLE than in MTLE seizures. CONCLUSIONS This difference between the two groups may provide a differentiation between an epileptic focus of mesial from neocortical temporal lobe origin.
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Affiliation(s)
- A Holl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
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Haussermann P, Wilhelm T, Keinath S, Stölzle C, Conrad B, Ceballos-Baumann A. Primary central nervous system lymphoma in the SMA presenting as rapidly progressive parkinsonism. Mov Disord 2001; 16:962-5. [PMID: 11746632 DOI: 10.1002/mds.1193] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report on a 56-year-old man who developed a rapidly progressive parkinsonism and apraxia over 2 months due to biopsy confirmed cerebral non-Hodgkin lymphoma primarily involving the SMA and parts of the superior frontal gyrus bilaterally.
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Affiliation(s)
- P Haussermann
- Department of Neurology, Klinikum rechts der Isar, TU Munich, Munich, Germany
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Nuti A, Ceravolo R, Salvetti S, Gambaccini G, Bonuccelli U, Capochiani E. Paraneoplastic choreic syndrome during non-Hodgkin's lymphoma. Mov Disord 2000; 15:350-2. [PMID: 10752595 DOI: 10.1002/1531-8257(200003)15:2<350::aid-mds1029>3.0.co;2-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- A Nuti
- Department of Neuroscience, University of Pisa, Italy
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Ferreri AJ, Reni M, Villa E. Primary central nervous system lymphoma in immunocompetent patients. Cancer Treat Rev 1995; 21:415-46. [PMID: 8556717 DOI: 10.1016/0305-7372(95)90028-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A J Ferreri
- Department of Radiochemotherapy, San Raffaele Hospital, Milan, Italy
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Laing RW, Howell SJ. Acute bilateral ballism in a patient with intravascular dissemination of gastric carcinoma. Neuropathol Appl Neurobiol 1992; 18:201-5. [PMID: 1620279 DOI: 10.1111/j.1365-2990.1992.tb00780.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An 84-year-old woman presented with an acute onset of violent bilateral ballism-chorea. She was admitted to the local neurology unit, but not definite diagnosis could be made of the underlying condition, although she did appear to have bronchopneumonia. At autopsy the stomach wall was thickened, and the lesser curve lymph nodes were firm and enlarged. A single nodule was noted in the liver while the lungs appeared consolidated. Histology revealed a moderate-to-poorly differentiated gastric adenocarcinoma with extensive intravascular dissemination which included the central nervous system (CNS). Numerous small infarcts related to vessels occluded by tumour were present throughout the brain, and we feel that this was the underlying mechanism for the acute onset of ballism.
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Affiliation(s)
- R W Laing
- Department of Neuropathology, Royal Hallamshire Hospital, Sheffield
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Abstract
Primary CNS lymphomas (PCNSL), until recently representing about 1% of all brain tumors, show dramatically increased incidence both in high-risk groups (immunocompromised, AIDS) and in the general population. They are extranodal diffuse non-Hodgkin's lymphomas, the morphology and classification of which are identical to those of systemic lymphomas, although PCNSL show different biological behavior and diagnosis according to the New Working Formulation and updated Kiel classification may be difficult. The majority are large B cell variants of high-grade malignancy; low-grade subtypes and T cell lymphomas are rare. Sixty per cent occur in the supratentorial space (hemispheres, periventricular) and 12% in the posterior fossa; 30% are multiple (50%-70% in AIDS). PCNSL show a male preponderance with a peak incidence in the 5th-7th decade (3rd-4th in AIDS). The duration of diffuse or focal clinical symptoms averages 1-2 months. Computed tomography and magnetic resonance imaging scans show single or multiple or diffuse, often typical lesions. Diagnosis is achieved by evaluation of stereotactic biopsy material or cerebrospinal fluid cytology using immunocytological markers. Current therapy in immunocompetent patients, radiation plus corticosteroids and pre- or postradiation polychemotherapy, shows response rates of 85% with a median survival of 17-44 months, a prognosis similar to that for glioblastoma. Meningeal PCNSL is treated with intrathecal methotrexate or cytosine arabinoside. Transliquoral seeding of PCNSL is frequent, distant metastases occurring in 6%-8%. Therapy of AIDS-related PCNSL makes use of radiation and corticosteroids, and rarely of chemotherapy. The pathogenesis of PCNSL is unknown, but Epstein-Barr virus may be a contributory factor.
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