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Navickaitė I, Ališauskienė M, Petrauskienė S, Žemgulytė G. Sarcoidosis-Associated Sensory Ganglionopathy and Harlequin Syndrome: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1495. [PMID: 37629785 PMCID: PMC10456357 DOI: 10.3390/medicina59081495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Sensory ganglionopathy is a rare neurological disorder caused by degeneration of the neurons composing the dorsal root ganglia. It manifests as various sensory disturbances in the trunk, proximal limbs, face, or mouth in a patchy and asymmetrical pattern. Harlequin syndrome is characterized by unilateral flushing and sweating of the face, neck, and upper chest, concurrent with contralateral anhidrosis. Here, we present and discuss a clinical case of sarcoidosis-associated ganglionopathy and Harlequin syndrome. Case presentation: A 31-year-old woman complained of burning pain in the right side of the upper chest and the feet. She also experienced episodes of intense flushing and sweating on the right side of her face, neck, and upper chest. Three years before these symptoms began, the patient was diagnosed with pulmonary sarcoidosis. On neurological examination, sensory disturbances were present. In the trunk, the patient reported pronounced hyperalgesia and allodynia in the upper part of the right chest and some patches on the right side of the upper back. In the extremities, hypoalgesia in the tips of the fingers and hyperalgesia in the feet were noted. An extensive diagnostic workup was performed to eliminate other possible causes of these disorders. A broad range of possible metabolic, immunological, and structural causes were ruled out. Thus, the final clinical diagnosis of sarcoidosis-induced sensory ganglionopathy, small-fiber neuropathy, and Harlequin syndrome was made. Initially, the patient was treated with pregabalin and amitriptyline, but the effect was inadequate for the ganglionopathy-induced pain. Therefore, therapeutic plasma exchange as an immune-modulating treatment was selected, leading to partial pain relief. Conclusions: This case report demonstrates the possible autoimmune origin of both sensory ganglionopathy and Harlequin syndrome. It suggests that an autoimmune etiology for these disorders should be considered and the diagnostic workup should include screening for the most common autoimmune conditions.
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Affiliation(s)
- Ieva Navickaitė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (M.A.); (G.Ž.)
| | - Miglė Ališauskienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (M.A.); (G.Ž.)
| | - Sandra Petrauskienė
- Department of Preventive and Paediatric Dentistry, Lithuanian University of Health Sciences, Luksos-Daumanto Str. 6, LT-50106 Kaunas, Lithuania;
| | - Gintarė Žemgulytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (M.A.); (G.Ž.)
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Shimada T, Nakajima S, Nakamura R, Kurita N, Ogaki K, Watanabe M, Yamashiro K, Urabe T. Hashimoto's encephalopathy with gait disturbance caused by sensory ganglionopathy: A case report and review of the literature. eNeurologicalSci 2021; 25:100370. [PMID: 34660918 PMCID: PMC8502713 DOI: 10.1016/j.ensci.2021.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
Hashimoto's encephalopathy (HE) is a steroid-responsive encephalopathy characterized by several neurological symptoms. HE mainly involves the central nervous system; the peripheral nervous system is rarely involved. We treated a previously healthy elderly man showing mild cognitive decline and subacute progressive gait disturbance due to severe sensory deficits, including sensation of touch and deep sensation with elevated anti-NH2 terminal of α-enolase and anti-thyroid antibodies. His sensory disturbance symptoms improved after steroid therapy, suggesting that the neuropathy was related to HE. His disease was characteristic of HE in that his sensory deficits responded well and rapidly to steroid therapy. A nerve conduction study showed reduced sensory nerve action potentials in all limbs, indicating that his neuropathy was not “axonopathy”, but “sensory ganglionopathy”, which can occur concurrently with autoimmune disorders. Dysautonomia may be the responsible pathomechanism because of the vulnerability of the blood–nerve barrier at the ganglia. Although the pathophysiology of HE has not been clearly elucidated, autoimmune inflammation has been reported in a number of autopsy cases, indicating that sensory ganglionopathy can develop with HE. Therefore, HE should be recognized as one type of “treatable neuropathy”.
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Affiliation(s)
- Tomoyo Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryota Nakamura
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naohide Kurita
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kotaro Ogaki
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
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Rossor AM, Jaunmuktane Z, Rossor MN, Hoti G, Reilly MM. TDP43 pathology in the brain, spinal cord, and dorsal root ganglia of a patient with FOSMN. Neurology 2019; 92:e951-e956. [PMID: 30700593 PMCID: PMC6404468 DOI: 10.1212/wnl.0000000000007008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To describe the histopathologic features of a case of facial-onset sensory and motor neuronopathy (FOSMN). Methods We describe a postmortem examination performed on a 54-year-old man with FOSMN associated with personality change. Results Postmortem examination revealed TAR DNA-binding protein (TDP) 43 proteinopathy with widespread distribution. TDP43 pathology was seen in the neurons and glial cells and was most pronounced in the subthalamic nucleus followed by the spinal cord, including dorsal root ganglia, brainstem, and other deep cerebral nuclei. In the medial temporal lobe, neocortex and subcortical hemispheric white matter TDP43 pathologic inclusions were very rare. In contrast to TDP43 pathologies associated with typical amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD)–TDP, in this case, there were more frequent TDP43-positive oligodendroglial, coiled body–like cytoplasmic inclusions than neuronal inclusions. Neuronal cytoplasmic TDP43 inclusions with globular and skein-like morphology were seen in both anterior horn cells and dorsal root ganglia. No β-amyloid, α-synuclein, or significant hyperphosphorylated tau pathology was seen. Conclusion This case provides further evidence that FOSMN is a neurodegenerative disease characterized by TDP43 pathology. Despite minimal cortical TDP43 pathology, the clinical features of the behavioral variant of FTD in this patient suggest that FOSMN may fall within or overlap with the FTD-ALS spectrum.
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Affiliation(s)
- Alexander M Rossor
- From the MRC Centre for Neuromuscular Diseases (A.M.R., M.M.R.), Department of Neurodegenerative Disease (Z.J.), Queen Square Brain Bank (Z.J., G.H.), and Dementia Research Centre (M.N.R.), UCL Institute of Neurology; National Hospital for Neurology and Neurosurgery (A.M.R., M.M.R., M.N.R.); and Division of Neuropathology (Z.J.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, UK
| | - Zane Jaunmuktane
- From the MRC Centre for Neuromuscular Diseases (A.M.R., M.M.R.), Department of Neurodegenerative Disease (Z.J.), Queen Square Brain Bank (Z.J., G.H.), and Dementia Research Centre (M.N.R.), UCL Institute of Neurology; National Hospital for Neurology and Neurosurgery (A.M.R., M.M.R., M.N.R.); and Division of Neuropathology (Z.J.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, UK
| | - Martin N Rossor
- From the MRC Centre for Neuromuscular Diseases (A.M.R., M.M.R.), Department of Neurodegenerative Disease (Z.J.), Queen Square Brain Bank (Z.J., G.H.), and Dementia Research Centre (M.N.R.), UCL Institute of Neurology; National Hospital for Neurology and Neurosurgery (A.M.R., M.M.R., M.N.R.); and Division of Neuropathology (Z.J.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, UK
| | - Glen Hoti
- From the MRC Centre for Neuromuscular Diseases (A.M.R., M.M.R.), Department of Neurodegenerative Disease (Z.J.), Queen Square Brain Bank (Z.J., G.H.), and Dementia Research Centre (M.N.R.), UCL Institute of Neurology; National Hospital for Neurology and Neurosurgery (A.M.R., M.M.R., M.N.R.); and Division of Neuropathology (Z.J.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, UK
| | - Mary M Reilly
- From the MRC Centre for Neuromuscular Diseases (A.M.R., M.M.R.), Department of Neurodegenerative Disease (Z.J.), Queen Square Brain Bank (Z.J., G.H.), and Dementia Research Centre (M.N.R.), UCL Institute of Neurology; National Hospital for Neurology and Neurosurgery (A.M.R., M.M.R., M.N.R.); and Division of Neuropathology (Z.J.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, UK.
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Rossor AM, Blake J, Pissanou T, Reilly MM. Sensory neuronopathy associated with cholangiocarcinoma diagnosed 6 years after symptom onset. BMJ Case Rep 2017; 2017:bcr-2016-217844. [PMID: 29269356 DOI: 10.1136/bcr-2016-217844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A pure sensory neuronopathy (also referred to as a sensory ganglionopathy) is one of a handful of classical neurological paraneoplastic syndromes. Current guidelines recommend that in cases of sensory neuronopathy, a search for an underlying malignancy be pursued for up to 4 years. We report the case of a 52-year-old woman with a sensory neuronopathy who was eventually diagnosed with a cholangiocarcinoma 6 years after the onset of her disease. A CT fluorodeoxyglucose positron emission tomography (FDG-PET) scan performed 18 and 24 months after disease onset failed to identify an underlying neoplasm. Immunomodulatory treatment with corticosteroids, intravenous immunoglobulins and plasma exchange were ineffective. Investigations for Sjogren's disease were negative. A third FDG-PET performed 6 years after symptom onset identified a cholangiocarcinoma, which was confirmed histologically following open resection. Since the tumour was removed, our patient's condition has not progressed, but there has been no improvement and she remains severely disabled.
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Affiliation(s)
- Alexander M Rossor
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Julian Blake
- Department of Neurophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Theodora Pissanou
- Sheila Sherlock Liver Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Abkur TM, Bede P. Clinical Reasoning: Reversible gait ataxia: From wheelchair to independent mobility. Neurology 2017; 88:e145-e149. [PMID: 28396457 DOI: 10.1212/wnl.0000000000003815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tarig Mohammed Abkur
- From the Department of Neurology (T.M.A., P.B.), Beaumont Hospital, Dublin; and Quantitative Neuroimaging Group (P.B.), Academic Unit of Neurology, Trinity College Dublin, Ireland.
| | - Peter Bede
- From the Department of Neurology (T.M.A., P.B.), Beaumont Hospital, Dublin; and Quantitative Neuroimaging Group (P.B.), Academic Unit of Neurology, Trinity College Dublin, Ireland
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Chronic idiopathic axonal polyneuropathy: a systematic review. J Neurol 2016; 263:1903-10. [DOI: 10.1007/s00415-016-8082-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 12/20/2022]
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Affiliation(s)
- Kelly Graham Gwathmey
- Department of Neurology; University of Virginia; P.O. Box 800394 Charlottesville Virginia 22908 USA
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