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Aboseif A, Palmer K, Abrams AW, Lachhwani D, Knight EMP, Valappil AMN, Zeft A. A not so incidental 'incidentaloma' - pediatric ganglioneuroma-associated cerebellar degeneration and super-refractory status epilepticus: case report and literature review. Front Neurol 2023; 14:1250261. [PMID: 37928156 PMCID: PMC10621035 DOI: 10.3389/fneur.2023.1250261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Paraneoplastic neurological disorders are rare in children, with paraneoplastic cerebellar degeneration (PCD) considered highly atypical. We describe a 13-year-old girl with progressive neurobehavioral regression, cerebellar ataxia, and intractable epilepsy presenting in super-refractory status epilepticus. After an extensive evaluation, her clinical picture was suggestive of probable autoimmune encephalitis (AE). Further diagnostic testing revealed a molecularly undefined neural-restricted autoantibody in both serum and CSF, raising suspicion over an adrenal mass previously considered incidental. Surgical resection led to a robust clinical improvement, and pathology revealed a benign ganglioneuroma. This report widens the spectrum of paraneoplastic manifestations of ganglioneuroma, reviews the diagnostic approach to antibody-negative pediatric AE, and raises important clinical considerations regarding benign and incidentally found tumors in the setting of a suspected paraneoplastic neurologic syndrome.
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Affiliation(s)
- Albert Aboseif
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Kaitlyn Palmer
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Aaron W. Abrams
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | | | | | | | - Andrew Zeft
- Center for Pediatric Rheumatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, United States
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2
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Zhang T, Pan ZB, Tong WJ, Zhou YL, Cheng Y, Jin DQ, Qi SQ, Zhang ZQ. A Case of Ulcerative Colitis Induced by Paraneoplastic Syndrome? J Inflamm Res 2023; 16:3319-3327. [PMID: 37576158 PMCID: PMC10422985 DOI: 10.2147/jir.s418733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
Background Paraneoplastic syndromes often cause endocrine, neurological, cutaneous, and hematologic pathologies, and cases with digestive symptoms as prominent cases are rare. Case Description A 1-year-old child admitted to the emergency department with severe abdominal distension was later diagnosed with sacrococcygeal yolk cystoma with ulcerative colitis. After symptomatic management, surgical removal of the tumor, and JEB chemotherapy, the symptoms of ulcerative colitis disappeared completely. After 7 years of follow-up, the child grew and developed well, and there was no recurrence of tumor and ulcerative colitis. Conclusion Yolk sac tumor with ulcerative colitis is a rare paraneoplastic syndrome with complex clinical manifestations.
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Affiliation(s)
- Tao Zhang
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Zhu-Bin Pan
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Wen-Jia Tong
- Department of Pediatric Intensive Care Unit, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Yu-Liang Zhou
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Yuan Cheng
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Dan-Qun Jin
- Department of Pediatric Intensive Care Unit, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Shi-Qin Qi
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Zhen-Qiang Zhang
- Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
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3
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Fava D, Morandi F, Prigione I, Angelelli A, Bocca P, Pistorio A, Volpi S, Patti G, Pepino C, Casalini E, Allegri AEM, Di Iorgi N, d’Annunzio G, Napoli F, Maghnie M. Blood Lymphocyte Subsets and Proinflammatory Cytokine Profile in ROHHAD(NET) and non-ROHHAD(NET) Obese Individuals. J Endocr Soc 2023; 7:bvad103. [PMID: 37564886 PMCID: PMC10411042 DOI: 10.1210/jendso/bvad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 08/12/2023] Open
Abstract
Context Rapid-onset obesity with central hypoventilation, hypothalamic dysfunction, and autonomic dysregulation with neural crest tumors (ROHHAD-NET) syndrome pathophysiology remains elusive. Acquired neuroimmunological dysfunction has been proposed as a possible pathogenetic pathway. Objective The aim of our study was to characterize lymphocyte subpopulations subsets in peripheral blood (PB) and to evaluate a panel of proinflammatory cytokines/chemokines in ROHHAD(NET) patients vs controls. Methods We included 11 ROHHAD(NET) patients, 7 ROHHAD and 4 ROHHAD-NET, selected by clinical criteria. Controls were 11 simple obese children, matched for age and sex. Flow cytometric analysis and enzyme-linked immunosorbent assay were performed on PB and serum samples of the 2 groups. Results Analysis revealed that T lymphocytes are significantly increased in ROHHAD(NET) patients (P = .04) with a prevalence of CD4-T cells (P = .03) and a lower number of activated CD8-T cells (P = .02). With regard to regulatory subset, patients displayed increased regulatory B cells (P = .05) and type-1 regulatory T cells (P = .03). With regard to CD8-T cells, a lower number of T effector memory was observed (P = .02). In contrast, among CD4-T cells, we found a higher number of T naive (P = .04) and T effector (P = .0008). Interleukin-8 (IL-8) levels and monocyte chemotactic protein-1 were increased in patients vs controls (P = .008 and P = .01, respectively). Furthermore, IL-8 levels were higher in the subgroup with neural tumor (P = .0058) (ROHHAD-NET) than in patients without neural tumor (ROHHAD). Soluble HLA-G was significantly lower in patients vs controls (P = .03). Conclusion Our findings contribute to support the hypothesis of immune dysregulation, which may underlie this complex, often fatal disease. Because ROHHAD(NET) syndrome is an ultra-rare disease, multicentric studies are needed to improve the effect of our data in the management of this condition.
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Affiliation(s)
- Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Fabio Morandi
- UOSD Cell Factory, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Ignazia Prigione
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessia Angelelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
| | - Paola Bocca
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Angela Pistorio
- Scientific Direction, Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Stefano Volpi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Carlotta Pepino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
| | - Anna Elsa Maria Allegri
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuseppe d’Annunzio
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Flavia Napoli
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
- Department of Pediatrics, Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Shore RM. Disorders of phosphate homeostasis in children, part 2: hypophosphatemic and hyperphosphatemic disorders. Pediatr Radiol 2022; 52:2290-2305. [PMID: 35536416 DOI: 10.1007/s00247-022-05373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/07/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Phosphorus, predominantly in the form of inorganic phosphate PO4-3, has many essential physiological functions. In the skeleton, phosphate and calcium form the mineral component and phosphate is also essential in regulating function of skeletal cells. Considerable advances have been made in our understanding of phosphate homeostasis since the recognition of fibroblast growth factor-23 (FGF23) as a bone-derived phosphaturic hormone. This second part of a two-part review of disorders of phosphate homeostasis in children covers hypophosphatemic and hyperphosphatemic disorders that are of interest to the pediatric radiologist, emphasizing, but not limited to, those related to abnormalities of FGF23 signaling.
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Affiliation(s)
- Richard M Shore
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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5
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Hayashi T, Nakane S, Mukaino A, Higuchi O, Yamakawa M, Matsuo H, Kimura K. Effectiveness of treatment for 31 patients with seropositive autoimmune autonomic ganglionopathy in Japan. Ther Adv Neurol Disord 2022; 15:17562864221110048. [PMID: 35966941 PMCID: PMC9364197 DOI: 10.1177/17562864221110048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Autoimmune autonomic ganglionopathy (AAG) is characterized by serum
autoantibodies against the ganglionic acetylcholine receptor (gAChR).
Immunomodulatory treatments may alleviate AAG symptoms, but the most
appropriate treatment strategy is unclear. Objective: This study aimed to confirm the effectiveness of treatments, particularly
immunotherapy, in patients with seropositive AAG in Japan, as well as to
determine the most effective treatment and the best assessment method for
clinical response to treatment. Methods: We collected data from a previous cohort study of patients with seropositive
AAG. The clinical autonomic and extra-autonomic symptoms were objectively
counted and subjectively assessed using the modified Composite Autonomic
Symptom Score. Post-treatment changes in the gAChR antibody level were
evaluated. Results: Thirty-one patients received immunotherapy. Among them, 19 patients received
intravenous methylprednisolone; 27, intravenous immunoglobulin; 3, plasma
exchange; 18, oral steroids; 2, tacrolimus; 1, cyclosporine; and 1,
mycophenolate mofetil. Patients who received immunotherapy showed
improvements in the total number of symptoms (from 6.2 ± 2.0 to 5.1 ± 2.0)
and modified Composite Autonomic Symptom Score (from 37.4 ± 15.3 to
26.6 ± 12.8). Orthostatic intolerance, sicca, and gastrointestinal symptoms
were ameliorated by immunotherapy. Immunotherapy decreased the antibody
levels (gAChRα3 antibodies, from 2.2 ± 0.4 to 1.9 ± 0.4,
p = 0.08; gAChRβ4 antibodies, from 1.6 ± 0.1 to 1.0 ± 0.2,
p = 0.002), but antibody levels increased in 10
patients despite immunotherapy. The rate of improvement in the total number
of symptoms was higher in patients with combined therapy than in patients
with non-combined therapy (70.7% vs 28.6%). Conclusions: The scores in many items on the rating scale decreased after immunotherapy in
patients with seropositive AAG, particularly in the combined immunotherapy
group. However, more accurate assessment scales for clinical symptoms and
multicenter randomized, placebo-controlled prospective studies are warranted
to establish future treatment strategies.
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Affiliation(s)
| | - Shunya Nakane
- Department of Neurology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Akihiro Mukaino
- Department of Japanese Oriental Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Osamu Higuchi
- Department of Clinical Research, NHO Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Makoto Yamakawa
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidenori Matsuo
- Department of Neurology, NHO Nagasaki Hospital, Nagasaki, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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Tiwari S, Arimbrakkunnan M, Yadav T, Vyas V, Rathod KK, Vishwajeet V. Thoracic Ganglioneuroma Presenting with Paraneoplastic Cerebellitis and ROHHAD-NET Syndrome. Ann Indian Acad Neurol 2022; 25:307-309. [PMID: 35693680 PMCID: PMC9175397 DOI: 10.4103/aian.aian_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mufeed Arimbrakkunnan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kirti K Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikarn Vishwajeet
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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7
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Fernández Escobar V, Del Pozo Carlavilla M, Ruiz Garcia R, Buedo Rubio MI. Paraneoplastic cerebellar syndrome secondary to rhabdomyosarcoma: a very rare aetiology. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:645-646. [PMID: 34238717 DOI: 10.1016/j.nrleng.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - R Ruiz Garcia
- Servicio de Inmunología, Centro de Diagnóstico Biomédico, Hospital Clinic de Barcelona, Barcelona, Spain
| | - M I Buedo Rubio
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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8
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Autoimmune Encephalitis in Tunisia: Report of a Pediatric Cohort. J Immunol Res 2021; 2021:6666117. [PMID: 34056010 PMCID: PMC8131150 DOI: 10.1155/2021/6666117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/18/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
Background Autoimmune encephalitis (AE) is a rapidly progressive encephalopathy caused by antibodies targeting neurons in the central nervous system generating specific immune responses. It is increasingly recognized in children. Objective To describe clinical, neuroimaging, and laboratory features, treatment, and outcome in a cohort of Tunisian children with AE. Methods We conducted a retrospective review of the medical records of all children attending the Department of Child and Adolescent Neurology (Tunis) with autoimmune encephalitis between 2004 and 2020. Clinical, neuroimaging, laboratory features, therapeutic data, and outcome were analyzed. Results Nineteen children were included in the study (12 girls and 7 boys). The median age at diagnosis was 7.68 years (range: 10 months-13 years). The most frequent manifestations were seizures and behavioral disorders. Eleven cases were diagnosed with anti-NMDA receptor encephalitis, 4 cases with anti-Ma2 encephalitis, 3 cases with anti-GAD encephalitis, and 1 case with anti-SOX1 encephalitis. Brain MRI showed increased T2 and fluid-attenuated inversion recovery (FLAIR) signal of the temporal lobe in 5 patients. Eighteen patients showed improvement following first-line immunotherapy (high-dose corticosteroids, intravenous immunoglobulin). One patient with anti-GAD encephalitis died despite escalating immunotherapy. Conclusion Diagnosis of autoimmune encephalitis is challenging in children, because of misleading presentations. An early and accurate diagnosis is important to enable proper therapeutic interventions.
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田 茂, 雷 文, 郎 长, 李 娟, 谭 君, 束 晓. [Fever for 2 months and disturbance of consciousness for 1 week in a preschool-aged girl]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:519-523. [PMID: 34020744 PMCID: PMC8140330 DOI: 10.7499/j.issn.1008-8830.2101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome (ROHHADS) is a rare multi-system disease, and delayed diagnosis and treatment may lead to catastrophic cardiopulmonary complications. As far as we know, no patient with ROHHADS has been reported in China, and this article reports a child with ROHHADS to improve the awareness of this disease among clinicians. A girl, aged 3 years, had the clinical manifestations of rapid weight gain, fever, disturbance of consciousness, and convulsion. The physical examination showed a body weight of 20 kg, somnolence, irregular breathing, and stiff neck. She had increased blood levels of prolactin and follicle-stimulating hormone and hyponatremia. The lumbar puncture showed an increased intracranial pressure. The brain MRI and magnetic resonance venography showed symmetrical lesions in the periventricular region and venous thrombosis in the right transverse sinus and the superior sagittal sinus. The sleep monitoring showed hypopnea. The girl was finally diagnosed with ROHHADS and intracranial venous thrombosis. She recovered after symptomatic treatment including decreasing intracranial pressure, anticoagulation, and respiratory support. The possibility of ROHHADS should be considered for patients with unexplained obesity, fever, and hypoventilation, with or without central nervous system symptoms. Early diagnosis and standardized follow-up can improve the prognosis of children with ROHHADS.
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Affiliation(s)
- 茂强 田
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 文婷 雷
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 长会 郎
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 娟 李
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 君梅 谭
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 晓梅 束
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
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10
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Gordon K, Ahmad N. Para-neoplastic optic neuritis presenting in a child with fusion positive localised para-testicular alveolar rhabdomyosarcoma. Pediatr Hematol Oncol 2021; 38:397-402. [PMID: 33095072 DOI: 10.1080/08880018.2020.1836100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present the case of a 13 year old boy, with sudden onset painful unilateral visual loss, prior to commencing chemotherapy for alveolar rhabdomyosarcoma. Cases of para-neoplastic optic neuritis have been reported in adult cancer patients, however there are no published reports of this phenomenon occurring in children. Our patient had full recovery of his vision, following 6 weeks treatment with steroids, immunoglobulins and standard chemotherapy as per high risk arm of European pediatric soft tissue sarcoma group (EpSSG) Rhabdomyosarcoma (RMS) 2005 guidelines. Our case highlights that para-neoplastic optic neuritis can occur in children. In pediatric patients presenting with optic neuritis and normal auto-antibody screen, an occult or underlying tumor should be considered.
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Affiliation(s)
- Katherine Gordon
- Department of Pediatrics, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Naveed Ahmad
- Department of Pediatrics, Royal Aberdeen Children's Hospital, Aberdeen, UK.,Department of Pediatric Hematology & Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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11
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Fernández Escobar V, Del Pozo Carlavilla M, Ruiz Garcia R, Buedo Rubio MI. Paraneoplastic cerebellar syndrome secondary to rhabdomyosarcoma: a very rare aetiology. Neurologia 2020; 36:S0213-4853(20)30308-X. [PMID: 33176919 DOI: 10.1016/j.nrl.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - R Ruiz Garcia
- Servicio de Inmunología, Centro de Diagnóstico Biomédico, Hospital Clínic de Barcelona, Barcelona, España
| | - M I Buedo Rubio
- Complejo Hospitalario Universitario de Albacete, Albacete, España
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12
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Abstract
Both the onset of various malignancies as well as the treatment of cancer can lead to neurologic symptoms which can be difficult to diagnose. In this review, we highlight the varied ways in which neurologic sequelae of cancer and its treatment manifest in children. Initial neurologic presentation may be secondary to mass effect or to immune-mediated paraneoplastic syndromes. Treatment effects on the nervous system may arise from surgery, chemotherapy, radiation, or bone marrow transplantation. In addition, the rapidly expanding field of immunotherapies for cancer has generated numerous new approaches to eradicating cancer including monoclonal antibodies, checkpoint inhibitors, and chimeric antigen receptor T cells (CAR-T cells), which have neurologic side effects mediated by immune responses that are also being recognized. Here we review common consult questions to the neurologist and our general approach to these scenarios including altered mental status, headaches, seizures, and sensorimotor complaints, considering the multifactorial nature of each.
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Affiliation(s)
- Caren Armstrong
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA.
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13
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Kiernan MC, Cornblath DR. Subacute sensory neuronopathy and cancer: the identification of paraneoplastic syndromes. J Neurol Neurosurg Psychiatry 2020; 91:793-794. [PMID: 32245767 DOI: 10.1136/jnnp-2020-323171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia .,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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