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Xu C, Wu H, Chen J. Case report: Paraneoplastic lower motor neuronopathy associated with a malignant liver tumor. Front Neurol 2024; 15:1325318. [PMID: 38410199 PMCID: PMC10894957 DOI: 10.3389/fneur.2024.1325318] [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: 10/21/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Paraneoplastic lower motor neuronopathies (LMNs) have rarely been reported with malignant liver tumors. A 71-year-old man developed chronic progressive upper limb and cranial nerve paralysis. Electromyography examination suggests chronic progressive neuronal damage involving the right C4-T1 nerve root innervated muscle and the right sternocleidomastoid muscle. Magnetic resonance imaging suggested the presence of a malignant liver tumor. His serum was positive for anti-Yo antibodies. Hepatic artery chemoembolization was performed, followed by treatment with pembrolizumab and lenvatinib. The patient's condition improved, and paraneoplastic LMNs were diagnosed. Paraneoplastic causes should be considered in the differential diagnosis of chronic progressive LMNs. A combination of surgical treatment and immunotherapy may result in a favorable outcome.
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Affiliation(s)
- Chaowei Xu
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Hanfan Wu
- Department of Electro Neurophysiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jian Chen
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Granger A, Rajnauth T, Lahoria R, Dubey D, Mills J, Mauermann ML, Berini SE, Spinner RJ, Dyck PJB, Klein CJ. Clinicopathologic Findings in Patients With Paraneoplastic Neuropathies and Antibodies Strongly Associated With Cancer. Neurology 2024; 102:e207982. [PMID: 38165318 DOI: 10.1212/wnl.0000000000207982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pathologic descriptions of peripheral nerve involvement in paraneoplastic neuropathies are sparse, mostly from autopsies focusing on CNS and dorsal root ganglia tissues. Here, we describe the clinicopathologic features of peripheral nerve biopsies in patients with paraneoplastic neurologic syndromes to expand the currently limited knowledge. METHODS Retrospective review of the Mayo Clinic electronic medical record from 1995 to 2022 for patients identified to have subacute onset neuropathy with paraneoplastic antibodies identified in our neuroimmunology laboratory having available nerve biopsies performed at the time of diagnosis. Patients with another cause of neuropathy not linked to their subacute onset were excluded. RESULTS Nineteen patients met inclusion criteria: 4 with amphiphysin antibodies, 6 with antineuronal nuclear antibody (ANNA)-1 only, 3 with both ANNA-1 and collapsin response-mediator protein 5 (CRMP-5), 2 with ANNA-2, and 4 with CRMP-5 antibodies only. Fifteen biopsies had reduced the density of myelinated nerve fibers-4 with multifocality. Subperineurial edema was present in 17 biopsies. Prominent epineurial perivascular inflammation was present in 3 biopsies, all belonging to patients with a lumbosacral radiculoplexus neuropathy (LRPN) phenotype. DISCUSSION Axonal loss, subperineurial edema, and an absence of prominent inflammation are the most common findings in nerve biopsies of patients with paraneoplastic antibodies strongly associated with cancer. The LRPN phenotype was the only subset with inflammatory collections. Paraneoplastic autoantibody testing should be considered in patients with subacute onset neuropathies, with or without interstitial inflammatory findings.
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Affiliation(s)
- Andre Granger
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Tina Rajnauth
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Rajat Lahoria
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Divyanshu Dubey
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - John Mills
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Michelle L Mauermann
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Sarah E Berini
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Robert J Spinner
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - P James B Dyck
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
| | - Christopher J Klein
- From the Department of Neuromuscular Medicine and Peripheral Nerve Laboratory (A.G., T.R., D.D., J.M., M.L.M., S.E.B., P.J.B.D., C.J.K.), Mayo Clinic, Rochester, MN; The Canberra Hospital (R.L.), Garran, Australia; and Department of Neurosurgery (R.J.S.), Mayo Clinic Foundation, Rochester, MN
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Castro DV, Mendes J, Pinto L, Ferreira N, Pereira L. A Case of Primary Lung Adenocarcinoma With Two Uncommon Presentations: Neurological Paraneoplastic Syndrome and Pericardial Effusion. Cureus 2023; 15:e47753. [PMID: 38021972 PMCID: PMC10676287 DOI: 10.7759/cureus.47753] [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] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Lung cancer is the second most common cancer worldwide and remains the first cause of cancer death. The diagnosis of lung cancer is mostly made following evaluation for respiratory signs and symptoms but sometimes the first presentation may be atypical. Some symptoms may be related to the invasion of adjacent structures and others caused by an autoimmune-mediated process when cross-reactivity between tumor antigens and normal nervous tissues is responsible for paraneoplastic syndromes. We present a case of a young woman with a smoking history who first manifested with two uncommon presentations of lung cancer: a paraneoplastic neurological syndrome and a hemorrhagic pericardial effusion with cardiac tamponade.
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Affiliation(s)
- Diana V Castro
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
| | - Jorge Mendes
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
| | - Luísa Pinto
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
| | - Nuno Ferreira
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
| | - Luís Pereira
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
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Badawy M, Revzin MV, Consul N, Soliman M, Ganeshan DM, Heymann JC, Gaballah AH, Rao Korivi B, Morani AC, Javadi S, Elsayes KM. Paraneoplastic Syndromes from Head to Toe: Pathophysiology, Imaging Features, and Workup. Radiographics 2023; 43:e220085. [PMID: 36795597 DOI: 10.1148/rg.220085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Patients often have symptoms due to the mass effect of a neoplasm on surrounding tissues or the development of distant metastases. However, some patients may present with clinical symptoms that are not attributable to direct tumor invasion. In particular, certain tumors may release substances such as hormones or cytokines or trigger an immune cross-reactivity between malignant and normal body cells, resulting in characteristic clinical features that are broadly referred to as paraneoplastic syndromes (PNSs). Recent advances in medicine have improved the understanding of the pathogenesis of PNSs and enhanced their diagnosis and treatment. It is estimated that 8% of patients with cancer develop a PNS. Diverse organ systems may be involved, most notably the neurologic, musculoskeletal, endocrinologic, dermatologic, gastrointestinal, and cardiovascular systems. Knowledge of various PNSs is necessary, as these syndromes may precede tumor development, complicate the patient's clinical presentation, indicate tumor prognosis, or be mistaken for metastatic spread. Radiologists should be familiar with the clinical presentations of common PNSs and the selection of appropriate imaging examinations. Many of these PNSs have imaging features that can assist with arriving at the correct diagnosis. Therefore, the key radiographic findings associated with these PNSs and the diagnostic pitfalls that can be encountered during imaging are important, as their detection can facilitate early identification of the underlying tumor, reveal early recurrence, and enable monitoring of the patient's response to therapy. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Margarita V Revzin
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Nikita Consul
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Dhakshina M Ganeshan
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - John C Heymann
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Brinda Rao Korivi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Ajaykumar C Morani
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Sanaz Javadi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.)
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Geraldes V, Caldeira E, Afonso A, Machado F, Amaro-Leal Â, Laranjo S, Rocha I. Cardiovascular Dysautonomia in Patients with Breast Cancer. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2206271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Breast cancer is the most frequent malignant disease among women, being responsible for a considerable percentage of fatalities and comorbidities every year. Despite advances in early detection and therapy, evidence shows that breast cancer survivors are at increased risk of developing other chronic conditions, such as cardiovascular diseases.
Autonomic dysfunction is an emerging, but poorly understood topic that has been suggested as a risk factor for cardiovascular disease in breast cancer patients. It clinically manifests through persistently elevated heart rates and abnormal heart rate variability, even before any signs of cardiovascular dysfunction appear. Since changes in the left ventricular ejection fraction only manifest when myocardial injury has already occurred, it has been hypothesized that autonomic dysfunction can constitute an early biomarker of cardiovascular impairment in breast cancer patients.
This review focuses on the direct and indirect effects of cancer and its treatment on the autonomic nervous system in breast cancer patients. We highlight the mechanisms potentially involved in cancer and antineoplastic therapy-related autonomic imbalance and review the potential strategies to prevent and/or attenuate autonomic dysfunction.
There are gaps in the current knowledge; more research in this area is needed to identify the relevance of autonomic dysfunction and define beneficial interventions to prevent cardiovascular disease in breast cancer patients.
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Ganaraja VH, Rezk M, Dubey D. Paraneoplastic neurological syndrome: growing spectrum and relevance. Neurol Sci 2022; 43:3583-3594. [DOI: 10.1007/s10072-022-06083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Florian IA, Lupan I, Sur L, Samasca G, Timiș TL. To be, or not to be… Guillain-Barré Syndrome. Autoimmun Rev 2021; 20:102983. [PMID: 34718164 DOI: 10.1016/j.autrev.2021.102983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
Guillain-Barré Syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis on a global scale, being an autoimmune disorder wherein demyelination of the peripheral nerves occurs. Its main clinical features are a symmetrical ascending muscle weakness with reduced osteotendinous reflexes and variable sensory involvement. GBS most commonly occurs after an infection, especially viral (including COVID-19), but may also transpire after immunization with certain vaccines or in the development of specific malignancies. Immunoglobulins, plasmapheresis, and glucocorticoids represent the principal treatment modalities, however patients with severe disease progression may require supportive therapy in an intensive care unit. Due to its symptomology, which overlaps with numerous neurological and infectious illnesses, the diagnosis of GBS may often be misattributed to pathologies that are essentially different from this syndrome. Moreover, many of these require specific treatment methods distinct to those recommended for GBS, in lack of which the prognosis of the patient is drastically affected. Such diseases include exposure to toxins either environmental or foodborne, central nervous system infections, metabolic or serum ion alterations, demyelinating pathologies, or even conditions amenable to neurosurgical intervention. This extensive narrative review aims to systematically and comprehensively tackle the most notable and challenging differential diagnoses of GBS, emphasizing on the clinical discrepancies between the diseases, the appropriate paraclinical investigations, and suitable management indications.
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Affiliation(s)
- Ioan Alexandru Florian
- Department of Neurology, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania, Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania.
| | - Lucia Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Hicks CW, Wang D, Windham BG, Matsushita K, Selvin E. Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts. Sci Rep 2021; 11:19159. [PMID: 34580377 PMCID: PMC8476511 DOI: 10.1038/s41598-021-98565-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Peripheral neuropathy is associated with substantial morbidity, but risk factors other than diabetes are largely uncharacterized. The aim of this study was to describe the prevalence and risk factors for peripheral neuropathy in adults with and without diabetes from two different population-based studies in the US. We performed a cross-sectional analysis of 5200 black and white participants from NHANES (1999–2004, age 40–85 years) and 3362 black and white participants from the ARIC Study (2016–2017, age 70–89 years) who underwent monofilament testing for peripheral neuropathy using a shared protocol. We used logistic regression to quantify age, sex, and race-adjusted risk factor associations for peripheral neuropathy among middle-aged (40–69 years) and older (≥ 70 years) adults. The age, sex, and race-adjusted prevalence of peripheral neuropathy (decreased sensation on monofilament testing) was 10.4% for middle-aged adults in NHANES, 26.8% for older adults in NHANES, and 39.2% for older adults in ARIC. Diabetes was an important risk factor, but more strongly associated with peripheral neuropathy in middle-aged (OR ~ 5 for long-standing diabetes) compared to older adults (ORs ~ 1.5–2). Male sex (ORs ~ 2), black race (ORs ~ 1.3–1.5), and greater height (ORs ~ 1.5–3) were robust risk factors for peripheral neuropathy. Other risk factors included body mass index, education, and peripheral artery disease. The burden of peripheral neuropathy defined by abnormal monofilament testing among older adults is substantial, even among adults without diabetes. Studies are needed to understand the etiology and prognosis of peripheral neuropathy in the absence of diabetes.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
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Tolkovsky A, Kipervasser S, Fainmesser Y, Alcalay Y, Gadoth A. A paraneoplastic syndrome misdiagnosed as ALS: What are the red flags? A case report and review of the literature. J Neuroimmunol 2021; 358:577635. [PMID: 34217018 DOI: 10.1016/j.jneuroim.2021.577635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022]
Abstract
Background Paraneoplastic motor neuron disease (PMND) is a rare, non-classical form of paraneoplastic neurological syndrome (PNS). Anti-Hu and anti-CV2/CRMP5 PNS are mostly associated with small-cell lung cancer (SCLC) and consist of highly variable clinical syndromes, including sensory neuronopathy, cerebellar ataxia and/or limbic encephalitis. However, substantial motor impairment is uncommon, particularly when no sensory dysfunction co-exists. Case A 72-year-old man with a recent diagnosis of amyotrophic lateral sclerosis (ALS) was referred to our department of neurology for evaluation. The patient sub-acutely developed progressive neurological dysfunction including erectile dysfunction, behavioral changes, limb weakness, dysphagia, anorexia, as well as worsening stridor that necessitated tracheostomy due to bilateral vocal cord paralysis (BVCP). Neurological examination revealed motor weakness of upper and lower motor neuron origin with autonomic and cognitive dysfunction. Cerebrospinal fluid (CSF) analysis demonstrated pleocytosis, elevated protein, presence of oligoclonal bands (OCB), and neuronal antibody testing was positive for anti-Hu and anti-CV2/CRMP5. Based on these findings a diagnosis of a PNS was made. Evaluation for malignancy was negative, and immunosuppressive/immunomodulatory treatment was initiated but had little effect during fifteen months of follow-up. Conclusions Although PMND is very rare, in an atypical presentation, especially with features that are not usually present in ALS such as autonomic dysfunction, sensory disturbance or cognitive decline, this etiology should be in the differential diagnosis.
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Affiliation(s)
- Assaf Tolkovsky
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Svetlana Kipervasser
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Epilepsy Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Fainmesser
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuromuscular Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Alcalay
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Immunology Laboratory, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Gadoth
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sarezky J, Sachs G, Elinzano H, Stavros K. Cancer and Peripheral Nerve Disease. Clin Geriatr Med 2021; 37:289-300. [PMID: 33858611 DOI: 10.1016/j.cger.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with cancer may experience neuropathy at any stage of malignancy, ranging from symptoms that are the earliest signs of cancer to side effects of treatment. Peripheral nerves are affected most commonly in a symmetric, stocking-glove pattern. Sensory neuronopathies, plexopathies, and radiculopathies may also be seen. The most common type of neuropathy in patients with cancer is related to chemotherapy, and recently peripheral nerve complications have been described as an effect of immune checkpoint inhibitors too. Other causes include paraneoplastic syndromes, direct tumor infiltration, and radiation. Treatment focuses on addressing the underlying cancer and management of neuropathic pain.
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Affiliation(s)
- Jonathan Sarezky
- Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street APC5, Providence, RI 02903, USA
| | - George Sachs
- Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street APC5, Providence, RI 02903, USA
| | - Heinrich Elinzano
- Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street APC5, Providence, RI 02903, USA
| | - Kara Stavros
- Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street APC5, Providence, RI 02903, USA.
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12
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Roth P, Winklhofer S, Müller AMS, Dummer R, Mair MJ, Gramatzki D, Le Rhun E, Manz MG, Weller M, Preusser M. Neurological complications of cancer immunotherapy. Cancer Treat Rev 2021; 97:102189. [PMID: 33872978 DOI: 10.1016/j.ctrv.2021.102189] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
Immunotherapy has emerged as a powerful therapeutic approach in many areas of clinical oncology and hematology. The approval of ipilimumab, a monoclonal antibody targeting the immune cell receptor CTLA-4, has marked the beginning of the era of immune checkpoint inhibitors. In the meantime, numerous antibodies targeting the PD-1 pathway have expanded the class of clinically approved immune checkpoint inhibitors. Furthermore, novel antibodies directed against other immune checkpoints are currently in clinical evaluation. More recently, bispecific antibodies, which link T cells directly to tumor cells as well as adoptive T cell transfer with immune cells engineered to express a chimeric antigen receptor, have been approved in certain indications. Neurological complications associated with the use of these novel immunotherapeutic concepts have been recognized more and more frequently. Immune checkpoint inhibitors may cause various neurological deficits mainly by alterations of the peripheral nervous system's integrity. These include radiculopathies, neuropathies, myopathies as well as myasthenic syndromes. Side effects involving the central nervous system are less frequent but may result in severe clinical symptoms and syndromes. The administration of chimeric antigen receptor (CAR) T cell is subject to rigorous patient selection and their use is frequently associated with neurological complications including encephalopathy and seizures, which require immediate action and appropriate therapeutic measures. Close clinical monitoring for neurological symptoms is key for early recognition of immunotherapy-related side effects. Comprehensive diagnostic work-up and adequate therapeutic measures are essential to avoid further clinical deterioration and residual neurological deficits.
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Affiliation(s)
- Patrick Roth
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Antonia M S Müller
- Department of Medical Oncology and Hematology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
| | - Dorothee Gramatzki
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
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Gastrointestinal dysfunction in neuroinflammatory diseases: Multiple sclerosis, neuromyelitis optica, acute autonomic ganglionopathy and related conditions. Auton Neurosci 2021; 232:102795. [PMID: 33740560 DOI: 10.1016/j.autneu.2021.102795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 01/25/2023]
Abstract
Disorders of the nervous system can produce a variety of gastrointestinal (GI) dysfunctions. Among these, lesions in various brain structures can cause appetite loss (hypothalamus), decreased peristalsis (presumably the basal ganglia, pontine defecation center/Barrington's nucleus), decreased abdominal strain (presumably parabrachial nucleus/Kolliker-Fuse nucleus) and hiccupping and vomiting (area postrema/dorsal vagal complex). In addition, decreased peristalsis with/without loss of bowel sensation can be caused by lesions of the spinal long tracts and the intermediolateral nucleus or of the peripheral nerves and myenteric plexus. Recently, neural diseases of inflammatory etiology, particularly those affecting the PNS, are being recognized to contribute to GI dysfunction. Here, we review neuroinflammatory diseases that potentially cause GI dysfunction. Among such CNS diseases are multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein associated disorder, and autoimmune encephalitis. Peripheral nervous system diseases impacting the gut include Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy, acute autonomic ganglionopathy, myasthenia gravis and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both CNS and PNS. These neuro-associated GI dysfunctions may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction. Such patients may visit gastroenterologists or physicians first, before the neurological diagnosis is made. Therefore, awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.
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Glasser M, Chen J, Alzarah M, Wallace M. Non-opioid Analgesics and Emerging Therapies. Cancer Treat Res 2021; 182:125-142. [PMID: 34542880 DOI: 10.1007/978-3-030-81526-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pain is a common and debilitating symptom of cancer. Cancer-related pain can occur at any point along the continuum from diagnosis to treatment to survivorship1. A systematic review published in 2016 estimated the prevalence of cancer pain to be 55% in those undergoing antineoplastic treatment, 66.4% in advanced cancer, and 39.3% in the post-treatment population. Thirty-eight percent of cancer patients in this pooled analysis experienced moderate to severe pain2.
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Affiliation(s)
- Marga Glasser
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Jeffrey Chen
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA.
| | - Mohammed Alzarah
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
| | - Mark Wallace
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, 9300 Campus Point Dr, MC 7651, San Diego, USA
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Abstract
Objectives: Generally, neuropathies of peripheral nerves are a frequent condition (prevalence 2–3%) and most frequently due to alcoholism, diabetes, renal insufficiency, malignancy, toxins, or drugs. However, the vast majority of neuropathies has orphan status. This review focuses on the etiology, frequency, diagnosis, and treatment of orphan neuropathies. Methods: Literature review Results: Rareness of diseases is not uniformly defined but in the US an orphan disease is diagnosed if the prevalence is <1:200000, in Europe if <5:10000. Most acquired and hereditary neuropathies are orphan diseases. Often the causative variant has been reported only in a single patient or family, particularly the ones that are newly detected (e.g. SEPT9, SORD). Among the complex neuropathies (hereditary multisystem disorders with concomitant neuropathies) orphan forms have been reported among mitochondrial disorders (e.g. NARP, MNGIE, SANDO), spinocerebellar ataxias (e.g. TMEM240), hereditary spastic paraplegias (e.g UBAP1), lysosomal storage disease (e.g. Schindler disease), peroxisomal disorders, porphyrias, and other types (e.g. giant axonal neuropathy, Tangier disease). Orphan acquired neuropathies include the metabolic neuropathies (e.g. vitamin-B1, folic acid), toxic neuropathies (e.g. copper, lithium, lead, arsenic, thallium, mercury), infectious neuropathies, immune-mediated (e.g. Bruns-Garland syndrome), and neoplastic/paraneoplastic neuropathies. Conclusions: Though orphan neuropathies are rare per definition they constitute the majority of neuropathies and should be considered as some of them are easy to identify and potentially treatable, as clarification of the underlying cause may contribute to the knowledge about etiology and pathophysiology of these conditions, and as the true prevalence may become obvious only if all ever diagnosed cases are reported.
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Affiliation(s)
| | | | - Julia Wanschitz
- Department of Neurology, Medical University, Innsbruck, Austria
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Mulroy E, Anderson NE. Altered mental status in "Guillain-Barré syndrome" -a noteworthy clinical clue. Ann Clin Transl Neurol 2020; 7:2489-2507. [PMID: 33136342 PMCID: PMC7732251 DOI: 10.1002/acn3.51226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/19/2020] [Accepted: 09/26/2020] [Indexed: 01/01/2023] Open
Abstract
Guillain‐Barré syndrome (GBS) is widely regarded as a “pure” peripheral nervous system disorder. However, this simplistic interpretation belies the fact that central nervous system involvement, often manifesting as derangements in mental status can occur as a complication of the “pure” form of the disorder, as part of GBS variants, as well as in a number of mimic disorders. Despite being common in clinical practice, there is no guidance in the literature as to how to approach such scenarios. Herein, we detail our approach to these cases.
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Affiliation(s)
- Eoin Mulroy
- UCL Queen Square Institute of Neurology, London, UK
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Belviso I, Palermi S, Sacco AM, Romano V, Corrado B, Zappia M, Sirico F. Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions. J Funct Morphol Kinesiol 2020; 5:jfmk5020022. [PMID: 33467238 PMCID: PMC7739249 DOI: 10.3390/jfmk5020022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/11/2023] Open
Abstract
The brachial plexus represents a complex anatomical structure in the upper limb. This "network" of peripheral nerves permits the rearrangement of motor efferent fibers, coming from different spinal nerves, in several terminal branches directed to upper limb muscles. Moreover, afferent information coming from different cutaneous regions in upper limb are sorted in different spinal nerves through the brachial plexus. Severe brachial plexus injuries are a rare clinical condition in the general population and in sport medicine, but with dramatic consequences on the motor and sensory functions of the upper limb. In some sports, like martial arts, milder injuries of the brachial plexus can occur, with transient symptoms and with a full recovery. Clinical evaluation represents the cornerstone in the assessment of the athletes with brachial plexus injuries. Electrodiagnostic studies and imaging techniques, like magnetic resonance and high-frequency ultrasound, could be useful to localize the lesion and to define an appropriate treatment and a functional prognosis. Several conservative and surgical techniques could be applied, and multidisciplinary rehabilitative programs could be performed to guide the athlete toward the recovery of the highest functional level, according to the type of injury.
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Affiliation(s)
- Immacolata Belviso
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Stefano Palermi
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Anna Maria Sacco
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Veronica Romano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Bruno Corrado
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
- Musculoskeletal Radiology Unit, Varelli Institute, 80126 Naples, Italy
| | - Felice Sirico
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
- Correspondence: ; Tel.: +39-081-746-3508
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Paraneoplastic sensorimotor neuropathy associated with mediastinal germ cell tumor: favorable outcome after high-dose intravenous immunoglobulin therapy. Neurol Sci 2019; 41:723-725. [PMID: 31578653 DOI: 10.1007/s10072-019-04078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
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Park JE, Lee KM, Choi HY, Ahn SE, You MW. Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis: A case report with clinical follow-up over a 7-year period. Medicine (Baltimore) 2019; 98:e14997. [PMID: 31027052 PMCID: PMC6831240 DOI: 10.1097/md.0000000000014997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA. PATIENT CONCERNS A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated. DIAGNOSES The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy. INTERVENTIONS The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion. OUTCOMES MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up. LESSONS The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.
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Cancer-Related Neuropathic Pain. Cancers (Basel) 2019; 11:cancers11030373. [PMID: 30884837 PMCID: PMC6468770 DOI: 10.3390/cancers11030373] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 11/17/2022] Open
Abstract
Neuropathic pain in cancer is common and debilitating. It is important to differentiate neuropathic pain from other cancer-related pains as it is associated with worse pain outcomes and requires different treatment strategies. This review summarises recent updates to pain classification, aetiology, pain assessment and current recommendations for treatment in patients with cancer-related neuropathic pain.
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Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol 2019; 16:535-548. [DOI: 10.1038/s41571-019-0194-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Cittadini MC, Repossi G, Albrecht C, Di Paola Naranjo R, Miranda AR, Pascual‐Teresa S, Soria EA. Effects of bioavailable phenolic compounds from
Ilex paraguariensis
on the brain of mice with lung adenocarcinoma. Phytother Res 2019; 33:1142-1149. [DOI: 10.1002/ptr.6308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/18/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022]
Affiliation(s)
- María C. Cittadini
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, INICSA, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
| | - Gastón Repossi
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, INICSA, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, Instituto de Biología Celular, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
| | - Claudia Albrecht
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, INICSA, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Nutrición, CENINH, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
| | - Romina Di Paola Naranjo
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Maestro López, Ciudad Universitaria Córdoba Argentina
- Universidad Nacional de Córdoba, Secretaría de Ciencia y Tecnología, ISIDSA, Juan Filloy, Ciudad Universitaria Córdoba Argentina
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, ICYTAC, Juan Filloy, Ciudad Universitaria Córdoba Argentina
| | - Agustín R. Miranda
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, INICSA, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
| | | | - Elio A. Soria
- Consejo Nacional de Investigaciones Científicas y TécnicasCONICET, INICSA, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, Instituto de Biología Celular, De La Reforma Bv., Ciudad Universitaria Córdoba Argentina
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Ng E, Ekladious A, Gahlot P. Horses or zebras: a delayed diagnosis of meralgia paraesthetica. BMJ Case Rep 2018; 2018:bcr-2018-226905. [DOI: 10.1136/bcr-2018-226905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
PURPOSE OF REVIEW This article describes the methods of diagnosis and management of the sensory-predominant polyneuropathies. To simplify the approach to this category of patients, sensory-predominant polyneuropathies are divided broadly into either small fiber (or pain-predominant) neuropathies and large fiber (or ataxia-predominant) neuropathies, of which the sensory neuronopathies (dorsal root ganglionopathies) are highlighted. RECENT FINDINGS Physicians can now easily perform skin biopsies in their offices, allowing access to the gold standard pathologic diagnostic tool for small fiber neuropathies. Additional diagnostic techniques, such as corneal confocal microscopy, are emerging. Recently, small fiber neuropathies have been associated with a broader spectrum of diseases, including fibromyalgia, sodium channel mutations, and voltage-gated potassium channel antibody autoimmune disease. SUMMARY Despite advances in diagnosing small fiber neuropathies and sensory neuronopathies, many of these neuropathies remain refractory to treatment. In select cases, early identification and treatment may result in better outcomes. "Idiopathic" should be a diagnosis of exclusion and a thorough investigation for treatable causes pursued.
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Xu Q, Du W, Zhou H, Zhang X, Liu H, Song H, Wang X, Wei S. Distinct clinical characteristics of paraneoplastic optic neuropathy. Br J Ophthalmol 2018; 103:797-801. [DOI: 10.1136/bjophthalmol-2018-312046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022]
Abstract
ObjectiveParaneoplastic optic neuropathy (PON) is relatively uncommon, and the visual outcomes and prognosis of this disease have not been well documented. The aim of this study was to investigate the clinical features and prognosis of antibody-mediated PON.MethodsClinical data were retrospectively collected from hospitalised patients diagnosed with PON at the Neuro-Ophthalmology Department at the Chinese People’s Liberation Army General Hospital from January 2015 to June 2017.ResultsA total of seven patients (four females and three males, 13 involved eyes) were included with a mean age of 56.28±11.32 years (36–70 years). Simultaneous or early sequential bilateral eye involvement (5/7, 71.4%) was common in the patients with PON. Severe vision loss (≤0.1) was seen in 76.9% (10/13) of the eyes. There were 13 eyes in the acute phase of the disease, and six eyes presented with optic disc oedema. All patients had definite evidence of paraneoplastic-associated antibodies (three with serum positive for antiamphilphysin, one for anti-PNMA2 (Ma2/Ta), one for anti-Yo, one for anti-Ma2 and one for anti-CV2). All of the serum samples were negative for myelin oligodendrocyte glycoprotein antibody and two patients companied with seropositive for the aquaporin-4 antibody. Five patients had history of primary malignancy, including thyroid cancer, type B thymoma, testicular seminoma, cervical cancer and lung carcinoma. Two patients had positive paraneoplastic syndrome antibodies (anti-Yo and antiamphiphysin), but the solid tumour had not been found through a PET scan. Visual acuity in 9/13 (69.2%) eyes was below 0.1, and all of the patients survived to the follow-up with no metastatic lesions.ConclusionsPON is relative rare, with a predominance of bilateral involvement and more with a poor visual prognosis. Paraneoplastic antibody testing can contribute to the diagnosis of PON, distinct from other types of optic neuropathies, which can help doctors to find the primary cancer earlier to guide further treatment.
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Paediatric Intestinal Pseudo-obstruction: Evidence and Consensus-based Recommendations From an ESPGHAN-Led Expert Group. J Pediatr Gastroenterol Nutr 2018; 66:991-1019. [PMID: 29570554 DOI: 10.1097/mpg.0000000000001982] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chronic intestinal pseudo-obstructive (CIPO) conditions are considered the most severe disorders of gut motility. They continue to present significant challenges in clinical care despite considerable recent progress in our understanding of pathophysiology, resulting in unacceptable levels of morbidity and mortality. Major contributors to the disappointing lack of progress in paediatric CIPO include a dearth of clarity and uniformity across all aspects of clinical care from definition and diagnosis to management. In order to assist medical care providers in identifying, evaluating, and managing children with CIPO, experts in this condition within the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition as well as selected external experts, were charged with the task of developing a uniform document of evidence- and consensus-based recommendations. METHODS Ten clinically relevant questions addressing terminology, diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to June 2017 using a number of established electronic databases as well as repositories. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate outcome measures for the research questions. Levels of evidence and quality of evidence were assessed using the classification system of the Oxford Centre for Evidence-Based Medicine (diagnosis) and the GRADE system (treatment). Each of the recommendations were discussed, finalized, and voted upon using the nominal voting technique to obtain consensus. RESULTS This evidence- and consensus-based position paper provides recommendations specifically for chronic intestinal pseudo-obstruction in infants and children. It proposes these be termed paediatric intestinal pseudo-obstructive (PIPO) disorders to distinguish them from adult onset CIPO. The manuscript provides guidance on the diagnosis, evaluation, and treatment of children with PIPO in an effort to standardise the quality of clinical care and improve short- and long-term outcomes. Key recommendations include the development of specific diagnostic criteria for PIPO, red flags to alert clinicians to the diagnosis and guidance on the use of available investigative modalities. The group advocates early collaboration with expert centres where structured diagnosis and management is guided by a multi-disciplinary team, and include targeted nutritional, medical, and surgical interventions as well as transition to adult services. CONCLUSIONS This document is intended to be used in daily practice from the time of first presentation and definitive diagnosis PIPO through to the complex management and treatment interventions such as intestinal transplantation. Significant challenges remain to be addressed through collaborative clinical and research interactions.
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Abstract
This chapter reviews the diseases of the peripheral nerves from a neuropathologic point of view, with a special focus on specific morphologic changes, and includes a summary of the histopathologic methods available for their diagnosis. As the rate of obesity and the prevalence of type 2 diabetes increase, diabetic neuropathy is the most common cause of peripheral neuropathy. Many systemic disorders with metabolic origin, like amyloidosis, hepatic failure, vitamin deficiencies, uremia, lipid metabolism disorders, and others, can also cause axonal or myelin alterations in the peripheral nervous system. The most notable causes of toxic neuropathies are chemotherapeutic agents, alcohol consumption, and exposure to heavy metals and other environmental or biologic toxins. Inflammatory neuropathies cover infectious neuropathies (Lyme disease, human immunodeficiency virus, leprosy, hepatitis) and neuropathies of autoimmune origin (sarcoidosis, Guillain-Barré syndrome/acute inflammatory demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy, and diverse forms of vasculitis. The increasing number of known diseases causing gene mutations in hereditary peripheral neuropathies requires precise characterization, which includes histopathology.
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Akpinar ÇK, Erdem Tilki H, Şahin H, Özbenli T. Carcinoid Tumor-Associated Paraneoplastic Polyneuropathy that Mimics Guillain-Barre Syndrome. Noro Psikiyatr Ars 2016; 53:368-369. [PMID: 28360817 DOI: 10.5152/npa.2016.12429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Hacer Erdem Tilki
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Hüseyin Şahin
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Taner Özbenli
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Furlan JC, Robinson LR, Murray BJ. Clinical Reasoning: Stepwise paralysis in a patient with adenocarcinoma of lung. Neurology 2016; 86:e122-7. [PMID: 27001993 DOI: 10.1212/wnl.0000000000002496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Julio C Furlan
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada.
| | - Lawrence R Robinson
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Brian J Murray
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
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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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