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Sahoo SK, Singh K, Chatterjee D, Ahuja CK, Dutta P, Dhandapani S. Giant skull base mass need not be a tumor - a rare presentation of IgG4-related disease. Br J Neurosurg 2023; 37:1820-1823. [PMID: 34114903 DOI: 10.1080/02688697.2021.1932746] [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] [Received: 10/27/2020] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Giant intracranial 'IgG4-related' lesions are uncommon. They may present as pachymeningitis or localized mass. Here we report, probably, the largest IgG4 skull base mass ever to be reported. CASE A 40-year male presented with headache, diplopia, right-sided sensori-neuronal hearing loss, and left spastic hemiparesis. Magnetic resonance imaging showed a lesion of 8.5 cm extending from the paranasal sinuses to the right petroclival region with uniform contrast enhancement and T2 hypointensity. Endonasal biopsy revealed respiratory epithelium with fibrosis, and lymphoplasmacytic infiltrate having IgG4 positive cells >30/HPF suggestive of 'IgG4-related' disease. Serum IgG4 was within normal levels. With oral prednisolone 60 mg given daily for 6 weeks and then tapered off over 8 weeks, he improved symptomatically. CONCLUSION Though rare, 'IgG4-related' disease can also present as a giant skull base mass and should be kept as a differential to fungal granulomas and meningiomas. As they improve dramatically with medical management, extensive skull base resection should not be planned before obtaining a tissue biopsy, especially when there is extension into paranasal sinuses and T2 hypointensity.
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Affiliation(s)
| | | | | | | | - Pinaki Dutta
- Department of Neurosurgery, PGIMER, Chandigarh, India
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Baldizán Velasco L, Morales-Angulo C. Otologic manifestations of IgG4-related disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:320-331. [PMID: 36427792 DOI: 10.1016/j.otoeng.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
IgG4-related disease (IgG4-RD) is a systemic autoimmune fibroinflammatory disease characterized by multiorgan infiltration of IgG4-positive plasma cells, fibrosis and vasculopathy that determine dysfunction of the affected organ. This review aims to characterize the otologic manifestations of the disease. We have conducted a systematic review of the biomedical literature published describing cases of IgG4-RD with otologic manifestations. For the review, the bibliographic databases utilized were Pubmed, Web of Science and Scopus. We selected 48 cases from which we extracted several data collections. About 52% of the patients were male between the ages of 19 and 79 years. Otologic findings were characterized by pseudotumoral lesions that most often caused a clinical presentation similar to otitis media with effusion, with cochlear involvement or sensorineural hearing loss (uni- o bilateral). Less frequent presentations included auricular chondritis, eosinophilic otitis, or hypertrophic pachymeningitis. In 32 patients (67%) the otologic manifestation was the first symptom of the ER-IgG4. Sixteen patients (33%) were treated with mastoidectomies as a result of delayed diagnosis and lack of knowledge about this entity. Two patients needed a cochlear implant. Although the otologic manifestations of IgG4-RD are unusual, it is important for the otorhinolaryngologist to know the otologic manifestations of this entity as it can be the onset of the disease, in order to allow early diagnosis and adequate treatment, avoiding permanent sequelae.
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Affiliation(s)
| | - Carmelo Morales-Angulo
- Facultad de Medicina, Universidad de Cantabria, Santanter, Cantabria, Spain; Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Marqués de Valdecilla, Santanter, Cantabria, Spain; IDIVAL, Santander, Cantabria, Spain.
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3
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Jain A, Patnaik U, Singh K, Jayadevan J. Enigma of otologic immunoglobulin G4-related disease, COVID-19, and uncontrolled diabetes: The unholy trinity. Med J Armed Forces India 2022; 80:S0377-1237(22)00193-9. [PMID: 36504510 PMCID: PMC9721396 DOI: 10.1016/j.mjafi.2022.10.009] [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: 06/10/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
Otologic immunoglobulin G4-related disease (IgG4-RD) is a rare and a relatively newer pathology. COVID-19, IgG4-RD, and type 2 diabetes, all have independent capabilities to considerably affect the immune system. The immunological effects of COVID are a global conundrum; consequently, the association of this trio (otologic IgG4-RD, COVID-19, and type 2 diabetes), the only reported case in literature, paves the way for a fascinating interplay to explore the knowledge of which would help optimize treatment and improve disease outcomes.
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Affiliation(s)
- Ashish Jain
- Resident, Department of ENT, Armed Forces Medical College, Pune, India
| | - Uma Patnaik
- Professor & Head, Department of ENT, Armed Forces Medical College, Pune, India
| | - Kamalpreet Singh
- Associate Professor, Department of ENT, Armed Forces Medical College, Pune, India
| | - Jijesh Jayadevan
- Resident, Department of ENT, Armed Forces Medical College, Pune, India
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4
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Manifestaciones otológicas de la enfermedad relacionada con IgG4. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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IgG4-Related Sclerosing Disease of the Temporal Bone: A Systematic Review. Otol Neurotol 2022; 43:856-863. [PMID: 35941671 DOI: 10.1097/mao.0000000000003614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) involving the temporal bone is an uncommon and underrecognized pathology often mistaken for malignancy. This systematic review is the first that aims to thoroughly analyze IgG4-RD of the temporal bone. DATABASES REVIEWED Ovid MEDLINE, EMBASE, Cochrane Library, and Google Scholar. METHODS We used the following search keywords: "lgG4-RD," "skull," "skull base," "cranial," "temporal bone," "inner ear." We additionally manually searched the bibliographies of relevant articles. The JBI Critical Appraisal Checklist for Case Reports and Case Series was used to assess the risk of bias; because of the scarcity of the reports, data were available through limited case series and reports; thus, data synthesis was not possible. RESULTS We identified 17 studies with 22 cases with temporal bone involvement. The most common presenting symptoms were hearing loss, otalgia, and headache. The mastoid and petrous bone were the most affected anatomical areas. Both computed tomography and magnetic resonance imaging were used. Biopsies showed the characteristic lymphoplasmacytic infiltrate in all cases, with histopathology being the diagnostic modality that set the diagnosis. Most patients were treated with corticosteroids ± surgery or a combination of corticosteroids and immunosuppressants with 95.5% symptomatic response and disease control. CONCLUSION IgG4-RD of the temporal bone radiologically manifests as space-occupying, lytic lesions; clinically, it presents with vague otological symptoms. Diagnosis involves a thorough workup, with histopathology being crucial in setting a definite diagnosis. IgG4-RD tends to respond well to systemic corticosteroids, whereas surgery is mostly required for diagnostic purposes.
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Hofmeyr L, Herbst G, Pretorius E, Sarembock B, Taylor K, Roytowski D. Case Report: Diagnosis of Petrous Apex IgG4-Related Disease by Middle Cranial Fossa Craniotomy and Temporal Bone Biopsy. Front Neurol 2022; 13:874451. [PMID: 35756934 PMCID: PMC9218261 DOI: 10.3389/fneur.2022.874451] [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: 02/12/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Primary IgG4-related disease (IgG4-RD) of the temporal bone is a rare condition. Unlike typical petrous apicitis or Gradenigo syndrome, our patient presented exclusively with unilateral cranial nerve VI palsy and symptoms of diplopia. Skull base imaging demonstrated a destructive bony lesion in the petrous apex. Imaging and systemic investigations were insufficient to support a diagnosis. The diagnosis was achieved histologically after acquiring the specimen by middle cranial fossa craniotomy and temporal bone biopsy. This case report is thought to be the first published description of a diagnosis of IgG4-RD proven with the middle cranial fossa approach. Case Report We describe a 29-year-old female with primary IgG4-RD of the petrous apex of the temporal bone. This patient presented with a few-month history of left-sided headache and recent-onset diplopia due to paralysis of cranial nerve VI. Imaging demonstrated a petrous apex lesion, and comprehensive systemic investigations could not reach a diagnosis. A middle cranial fossa craniotomy and a biopsy of the temporal bone lesion were undertaken to establish the diagnosis. Histological confirmation of IgG4-RD was proven. Following treatment with corticosteroids, the patient experienced complete recovery and resolution of her symptoms. Conclusion This study describes a case of primary IgG4-RD of the petrous apex of the temporal bone that presented with diplopia and was diagnosed by middle fossa craniotomy and temporal bone biopsy. To the best of our knowledge, this is the first case description where primary diagnosis was made based on middle cranial fossa craniotomy and temporal bone biopsy.
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Affiliation(s)
- Louis Hofmeyr
- Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa.,Division of Otorhinolaryngology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | | | | | - Brian Sarembock
- Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | | | - David Roytowski
- Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa.,Division of Neurosurgery, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
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7
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Mayeku J, Deisch J, Lopez-Gonzalez MA. Immunoglobulin G4-related disease of the cavernous sinus with orbit invasion - A case report. Surg Neurol Int 2021; 12:557. [PMID: 34877043 PMCID: PMC8645509 DOI: 10.25259/sni_859_2021] [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: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background Immunoglobulin G4-related disease (IgG4-RD) is a rare systemic disease of unknown etiology. It is characterized by tissue infiltration caused by IgG4 plasma cells and sclerosing inflammation of various body organs. At present, there are very few reported cases of IgG4-RD invasion of cavernous sinus and the orbit. Case Description A 56-year-old female with a history of rheumatoid arthritis was presented with a gradual onset of right oculomotor, abducens, and trigeminal nerve deficits. Four weeks after the onset of symptoms, the patient developed gradual visual deficit. Following this, a trial of steroids was administered to the patient. However, the treatment did not work as expected and patient's condition worsened. She progressed on to suffer complete visual loss in the right eye. Extensive work-up conducted on her turned out to be nondiagnostic. After this, the patient was referred to us for our evaluation. Neuroimaging revealed a right-sided cavernous sinus and orbital apex lesion. Given the lack of diagnosis and response to steroid treatment, we recommended surgical intervention and performed a modified pterional and pretemporal approach with extradural anterior clinoidectomy and transcavernous approach. We performed a lesion biopsy and cavernous sinus decompression, which helped in the partial recovery of visual function. The pathology report was consistent with IgG4-RD. Conclusion IgG4-RD is a rare disease that occurs even less in combination with cavernous sinus and orbit invasion. The rarity of the disease and the diverse presentation of symptoms have sometimes caused delayed diagnosis and intervention. Patients who failed to respond to conservative management and patients in the fibrotic stage of the disease without other organ involvement may benefit from surgical intervention if amenable. Early suspicion, diagnosis, and intervention can facilitate better prognosis.
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Affiliation(s)
- Julie Mayeku
- Department of General Surgery, Loma Linda University, California, United States
| | - Jeremy Deisch
- Department of Neuropathology and Human Anatomy, Loma Linda University, California, United States
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8
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Greene JJ, Sadjadi R, Jowett N, Hadlock T. Facial Palsy, Radiographic and Other Workup Negative: FROWN. Neurol Clin Pract 2021; 11:e654-e660. [PMID: 34840879 DOI: 10.1212/cpj.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/21/2020] [Indexed: 11/15/2022]
Abstract
Objectives Slow-onset peripheral facial palsy is far less common than acute-onset peripheral facial palsy and necessitates diagnostic evaluation for benign or malignant tumors or other less common etiologies. In the rare scenario in which no clarifying etiology is discovered following long-term evaluation (no radiographic or hematologic abnormalities and an otherwise unremarkable evaluation), a diagnostic and management dilemma occurs. We present a series of patients with this possible new clinical entity: Facial palsy, Radiographic and Other Workup Negative (FROWN) and propose a management strategy for this diagnosis of exclusion. Methods A series of 3,849 patients presenting with facial palsy to a tertiary facial nerve center was retrospectively assessed to identify those with progressive loss of facial function over at least 1 month. Exclusion criteria were history, physical or hematologic findings indicative of known diseases associated with facial palsy, and radiographic studies demonstrating a benign or malignant tumor. Results Patients with slow-onset facial palsy constituted 5% (190 patients) of the cohort and were ultimately diagnosed with either a benign or malignant neoplasm or other facial nerve pathology. Fourteen patients with slow-onset facial palsy remained without a diagnosis following long-term evaluation and serial imaging. Eleven patients underwent dynamic facial reanimation surgery and facial nerve and muscle biopsy, with no clear histopathologic diagnosis. Conclusion Patients with slow-onset facial palsy with negative radiographic and medical evaluations over several years may be characterized as having FROWN, an idiopathic and as yet poorly understood condition, which appears to be amenable to facial reanimation but requires further investigation as to its pathophysiology.
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Affiliation(s)
- Jacqueline J Greene
- Department of Head and Neck Surgery-Otolaryngology (JJG, NJ, TH), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston; and Department of Neurology (RS), Massachusetts General Hospital, Boston
| | - Reza Sadjadi
- Department of Head and Neck Surgery-Otolaryngology (JJG, NJ, TH), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston; and Department of Neurology (RS), Massachusetts General Hospital, Boston
| | - Nate Jowett
- Department of Head and Neck Surgery-Otolaryngology (JJG, NJ, TH), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston; and Department of Neurology (RS), Massachusetts General Hospital, Boston
| | - Tessa Hadlock
- Department of Head and Neck Surgery-Otolaryngology (JJG, NJ, TH), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston; and Department of Neurology (RS), Massachusetts General Hospital, Boston
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9
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Amirbaigloo A, Esfahanian F, Mouodi M, Rakhshani N, Zeinalizadeh M. IgG4-related hypophysitis. Endocrine 2021; 73:270-291. [PMID: 33837927 DOI: 10.1007/s12020-021-02714-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
Hypophysitis is a rare pituitary inflammatory disorder classified in different ways. Immunoglobulin G4-related disease (IgG4-RD), also a rare disease is a systemic fibro-inflammatory condition characterized by infiltration of tissue with IgG4-positive plasma cells; however prevalence of both of them probably is underestimated. In this paper, we present an Iranian patient with biopsy-proven IgG4-related hypophysitis and then review the clinical characteristics, laboratory, imaging, pathologic findings and therapeutic management as well as prognosis of 115 published cases of hypophysitis secondary to IgG4-related disease.
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Affiliation(s)
| | - Fatemeh Esfahanian
- Department of Endocrinology and Metabolism, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marjan Mouodi
- Department of Endocrinology and Metabolism, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Rakhshani
- Department of Pathology, Firoozgar Hospital, Iran University of medical sciences, Tehran, Iran
| | - Mehdi Zeinalizadeh
- Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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10
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Zhang J, Zhao L, Zhou J, Dong W, Wu Y. Immunoglobulin G4-related periodontitis: case report and review of the literature. BMC Oral Health 2021; 21:279. [PMID: 34049546 PMCID: PMC8161922 DOI: 10.1186/s12903-021-01592-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/26/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory systemic disease of unknown etiology that can affect one or multiple organs. The disease can mimic many infectious and inflammatory diseases, mainly causing organ enlargement or hyperplasia. Its diagnosis primarily relies on clinical, serologic, and histological features (lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis of IgG4 + plasma cells). Here, we report a rare case of IgG4-related periodontitis, and review the relevant literatures. CASE PRESENTATION A 38-year-old Chinese man visited the Department of Periodontics with gingival enlargement, loose teeth, and tooth loss. The patient had very poor oral hygiene and a large amount of calculus. Gingivae were edematous with deep periodontal pockets and attachment loss. Panoramic radiography showed alveolar bone loss. Serologic examination showed that IgG was 23.70 g/L and IgG4 concentration was 2.800 g/L. There was significant lymphoplasmacytic infiltration, a storiform pattern of fibrosis, and mitotic figures with hematoxylin and eosin staining; immunohistochemical staining showed 10 scattered IgG4-positive plasma cells in a high-power field. The patient was diagnosed as IgG4-related periodontitis. He received a course of corticosteroids with periodontal therapy, and the enlargement was significantly improved without recurrence. CONCLUSION IgG4-RD in the oral and maxillofacial region mainly involves salivary glands, but this rare case was characterized by enlarged gingivae. The differential diagnosis of IgG4-RD should be based on the clinical features and serologic (IgG4) and histopathological examinations. Corticosteroid therapy is effective for most IgG4-RD patients. Taken together, we hope this case report and the literature review can help dentists to improve their understanding of the IgG4-RD.
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Affiliation(s)
- Jinmei Zhang
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Lei Zhao
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Jieyu Zhou
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Wei Dong
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Yafei Wu
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China.
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China.
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11
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Cler SJ, Sharifai N, Baker B, Dowling JL, Pipkorn P, Yaeger L, Clifford DB, Dahiya S, Chicoine MR. IgG4-Related Disease of the Skull and Skull Base-A Systematic Review and Report of Two Cases. World Neurosurg 2021; 150:179-196.e1. [PMID: 33746107 DOI: 10.1016/j.wneu.2021.03.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) is an inflammatory process that uncommonly can present in the skull base and calvarium and mimic a tumor but the nature of this condition is not well summarized in the neurosurgical literature. METHODS A review was performed of 2 cases of IgG4-RD in the skull base highlighting the diagnostic challenges with assessment of these skull base lesions, and a systematic review of relevant literature was carried out. RESULTS A systematic review of the literature conducted in accordance with PRISMA guidelines identified 113 articles, with 184 cases of IgG4-RD in the skull base or calvarium. The most commonly affected locations include the meninges, cavernous sinus, base of the posterior fossa, clivus, and mastoid bone. Headache, visual and auditory disturbances, cranial nerve dysfunction, and seizures were the most common presenting symptoms. Medical treatment was highly successful and most commonly consisted of corticosteroids coadministered with immunosuppressive agents such as rituximab. Prevalence seemed to be equal between sexes, and serum IgG4 levels were increased in 61% of patients. Delayed diagnosis and a need for multiple biopsies were reported in numerous cases. Two cases of skull base IgG4-RD from the authors' institution show the variable presentations of this disease. More invasive surgical biopsies were required in both cases, and corticosteroid treatment led to significant clinical improvement. CONCLUSIONS IgG4-RD is an uncommon condition with an increasing body of reported cases that can affect the skull base and calvarium and should be in the differential diagnosis, because delay in diagnosis and treatment may be common.
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Affiliation(s)
- Samuel J Cler
- Department of Neurosurgery, Washington University School of Medicine, Washington, D.C., USA.
| | - Nima Sharifai
- Department of Pathology and Immunology, Washington University School of Medicine, Washington, D.C., USA
| | - Brandi Baker
- Department of Neurology, Washington University School of Medicine, Washington, D.C., USA
| | - Joshua L Dowling
- Department of Neurosurgery, Washington University School of Medicine, Washington, D.C., USA
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University School of Medicine, Washington, D.C., USA
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, Washington, D.C., USA
| | - David B Clifford
- Department of Neurology, Washington University School of Medicine, Washington, D.C., USA; Department of Infectious Disease, Washington University School of Medicine, Washington, D.C., USA
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, Washington, D.C., USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, Washington, D.C., USA
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12
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Ren Q, Su J, Zhang D, Ding X. Otological IgG4-Related Disease With Inner Ear Involvement: A Case Report and Review of Literature. EAR, NOSE & THROAT JOURNAL 2020; 101:NP441-NP444. [PMID: 33325728 DOI: 10.1177/0145561320976411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory disease involving multiple organs. Some studies have reported otological manifestations of IgG4-RD, although most studies describe involvement of the middle ear, and reports on inner ear manifestations are limited. Here, we describe a case of a 30-year-old man with IgG4-RD involving the inner ear. This case demonstrated that IgG4-RD affected the inner ear and caused cochlear ossification. Cochlear implants may be considered for milder cases, and hormone and immunosuppressive therapy may control disease progression.
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Affiliation(s)
- Qinzhan Ren
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinfei Su
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daoxing Zhang
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuyong Ding
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Claeys E, Gheysens O, Meersseman W, Verbeken E, Blockmans D, Henckaerts L. Facial nerve palsy in giant-cell arteritis: case-based review. Rheumatol Int 2020; 41:481-486. [PMID: 32794114 DOI: 10.1007/s00296-020-04673-7] [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: 03/26/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
Abstract
Acute peripheral facial nerve palsy is most frequently idiopathic (Bell's palsy) or virally induced, but can also be due to several other conditions. A rare cause is underlying systemic or autoimmune disease. A 79-year-old man presented with peripheral facial nerve palsy, malaise, and fever. Physical examination revealed tenderness of the left temporal artery and reduced pulsatility. 18F-FDG-PET/CT and biopsy of the temporal artery confirmed the diagnosis of giant cell arteritis (GCA). Prompt institution of corticosteroid therapy produced rapid decrease in inflammatory markers and gradual improvement of the facial nerve palsy. We searched the MEDLINE, Embase, and Scopus databases to identify previous reports of peripheral nerve palsy in GCA, other vasculitides, and autoimmune diseases. Facial nerve palsy as the presenting symptom of GCA has very rarely been reported. Although temporal artery biopsy is the gold standard for diagnosis, it may be negative in up to one-third of cases. In doubtful cases, imaging can help establish the diagnosis. Ultrasound, 3 T MRI, and 18F-FDG-PET/CT have all been previously reported to be useful. Peripheral facial nerve palsy may very rarely be the presenting symptom of GCA. Early correct diagnosis is essential for starting appropriate therapy. In patients with atypical features, 18F-FDG-PET/CT may be useful for establishing the diagnosis.
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Affiliation(s)
- Eveline Claeys
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium.
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Wouter Meersseman
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eric Verbeken
- Department of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Liesbet Henckaerts
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Tanaka T, Fuga M, Teshigawara A, Hasegawa Y, Nishiwaki K, Murayama Y, Yokoo H. IgG4-Related Disease in the Frontal Convexity Concomitant with Smoldering Multiple Myeloma: A Case Report and Review of the Literature Regarding Therapeutic Implications. World Neurosurg 2020; 143:247-260. [PMID: 32768593 DOI: 10.1016/j.wneu.2020.07.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND We have reported an extremely rare case of a frontal convexity tumor diagnosed as IgG4-related disease (IgG4-RD) with unique neuroradiological images. CASE DESCRIPTION A 64-year-old man with a history of monoclonal gammopathy of undetermined significance and conservative treatment had presented with a left facial spasm. Computed tomography showed a high-density round tumor with perifocal edema in the right frontal convexity. Magnetic resonance imaging demonstrated unique findings, including low signal intensity on T1- and T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images, with slight gadolinium enhancement. The tumor was totally removed via right frontal craniotomy. It had been located in the subdural space, was not adherent to the dura, and was less vascular than meningiomas. Histological investigation demonstrated plasma cells that were strongly positive for IgG4 and contained κ and λ light chains at a ratio of 1.5:1. The serum IgG4 level was elevated. The tumor met the diagnostic criteria for IgG4-RD. The patient was followed up for 3 years during postoperative adjuvant steroid therapy. The steroid therapy was discontinued, and during the next 4 years, neither tumor recurrence nor symptoms were observed. CONCLUSION Intracranial IgG4-RD with smoldering monoclonal gammopathy of undetermined significance is extremely rare. We reviewed the differential diagnosis of plasma cell granuloma and plasmacytoma, therapeutic implications, and clinical outcomes. Complete resection of a conspicuous and solitary IgG4-RD lesion in the frontal convexity is simple and could provide a cure with less-aggressive adjuvant therapy.
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Affiliation(s)
- Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
| | - Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Kaichi Nishiwaki
- Department of Clinical Oncology and Hematology, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideaki Yokoo
- Department of Pathology, Gumma University Graduate School of Medicine, Maebashi, Japan
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15
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Marinelli JP, Marvisi C, Vaglio A, Peters PA, Dowling EM, Palumbo AA, Lane JI, Appelbaum EN, Sweeney AD, Carlson ML. Manifestations of Skull Base IgG4‐Related Disease: A Multi‐Institutional Study. Laryngoscope 2019; 130:2574-2580. [DOI: 10.1002/lary.28478] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 01/28/2023]
Affiliation(s)
- John P. Marinelli
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
| | - Chiara Marvisi
- Department of Rheumatology University of Modena and Reggio Emilia Modena Italy
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio” University of Firenze Firenze Italy
- Nephrology and Dialysis Unit, Meyer Children's University Hospital Firenze Italy
| | - Pierce A. Peters
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota U.S.A
| | - Eric M. Dowling
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
| | | | - John I. Lane
- Department of Radiology Mayo Clinic Rochester Minnesota U.S.A
| | - Eric N. Appelbaum
- Department of Otolaryngology–Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Alex D. Sweeney
- Department of Otolaryngology–Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota U.S.A
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16
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Melenotte C, Seguier J, Ebbo M, Kaphan E, Bernit E, Saillier L, Audoin B, Feyeux D, Daniel L, Roche PH, Graillon T, Dufour H, Boutière C, Girard N, Closs-Prophette F, Guillaud C, Tieulié N, Regent A, Harlé JR, Hamidou M, Mekinian A, Grados A, Schleinitz N. Clinical presentation, treatment and outcome of IgG4-related pachymeningitis: From a national case registry and literature review. Semin Arthritis Rheum 2019; 49:430-437. [DOI: 10.1016/j.semarthrit.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/13/2019] [Accepted: 05/06/2019] [Indexed: 12/31/2022]
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17
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AbdelRazek MA, Venna N, Stone JH. IgG4-related disease of the central and peripheral nervous systems. Lancet Neurol 2019; 17:183-192. [PMID: 29413316 DOI: 10.1016/s1474-4422(17)30471-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023]
Abstract
IgG4-related disease can involve nearly any organ system, including the central and peripheral nervous systems. The pathology findings are consistent from organ to organ, but careful clinicopathological correlation is necessary to establish the diagnosis. Many non-neurological and neurological inflammatory conditions, previously regarded as idiopathic in nature, are now recognised to fall within the spectrum of IgG4-related disease. The condition is highly treatable, but probably remains substantially under-recognised. In this Review, we offer an important and timely update on the current and emerging aspects of this neurological disease. Following a short overview of IgG4-related disease, we describe the current understanding of neurological findings, pathophysiology, approaches to diagnosis, and treatment of IgG4-related disease affecting the central and peripheral nervous systems.
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Affiliation(s)
| | - Nagagopal Venna
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - John H Stone
- Rheumatology Clinic, Massachusetts General Hospital, Boston, MA, USA.
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18
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Wuesthoff C, Allende A, Patel N. IgG4 disease of the ear: Report and review. SAGE Open Med Case Rep 2018; 6:2050313X18791428. [PMID: 30116527 PMCID: PMC6088471 DOI: 10.1177/2050313x18791428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/05/2018] [Indexed: 12/24/2022] Open
Abstract
In recent years, an immune-mediated disorder involving IgG4 has been described, which targets multiple organs and explains a number of disorders previously regarded as “idiopathic” or of unknown origin. Furthermore, the discovery of IgG4-related disease (IgG4-RD) has placed a number of pathologies within its spectrum, linking symptoms and conditions formerly considered isolated. Reports of the manifestations of IgG4-RD in the head and neck are scarce. Otological manifestations have been reported, but only a handful of cases are available in the literature. This is the first report of recalcitrant serous otitis media secondary to IgG4-RD, confirmed by immunohistopathology. A case of IgG4-RD of the middle ear is presented, manifesting itself as recalcitrant serous otitis media. The case is presented from an otolaryngological and histopathological perspective and briefly reviews this rare disorder. The importance of the awareness of IgG4-RD resides mainly in the fact that it is a treatable condition. This can potentially improve the quality of life of a number of patients, some of whom may not have had a clear diagnosis. A favorable response to glucocorticoids has been reported. In cases of persistent symptoms, immunosuppressive therapy has been used with success.
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Affiliation(s)
- Carolina Wuesthoff
- Deafness Research, Kolling Institute of Medical Research and Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alexandra Allende
- Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, NSW, Australia.,Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nirmal Patel
- Deafness Research, Kolling Institute of Medical Research and Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of ORL-Head and Neck Surgery, Macquarie University, Sydney, NSW, Australia
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19
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Thompson A, Whyte A. Imaging of IgG4-related disease of the head and neck. Clin Radiol 2017; 73:106-120. [PMID: 28501095 DOI: 10.1016/j.crad.2017.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
IgG4-related disease is a systemic, inflammatory disorder typically involving multiple organ systems. Several eponymous conditions described previously in the clinical and radiology literature are now recognised to be part of the IgG4-related disease spectrum. This includes multiple manifestations in the head and neck region, which are the subject of this review. Imaging can occasionally suggest the specific diagnosis of IgG4 disease. More commonly, it will be included in a limited differential diagnosis that requires clarification with the aid of image-guided biopsy. There are strict histopathological criteria for the diagnosis of IgG4-related disease.
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Affiliation(s)
- A Thompson
- Neurological Intervention and Imaging Service Western Australia, Level 1, G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Neurological Intervention and Imaging Service Western Australia, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia; Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia.
| | - A Whyte
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, WA 6008, Australia; School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC 3010, Australia
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20
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Baptista B, Casian A, Gunawardena H, D'Cruz D, Rice CM. Neurological Manifestations of IgG4-Related Disease. Curr Treat Options Neurol 2017; 19:14. [PMID: 28374231 PMCID: PMC5378735 DOI: 10.1007/s11940-017-0450-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT IgG4-related disease (IgG4-RD) is a multisystem inflammatory disorder. Early recognition of IgG4-RD is important to avoid permanent organ dysfunction and disability. Neurological involvement by IgG4-RD is relatively uncommon, but well recognised-hypertrophic pachymeningitis and hypophysitis are the most frequent manifestations. Although the nervous system may be involved in isolation, this more frequently occurs in conjunction with involvement of other systems. Elevated circulating levels of IgG4 are suggestive of the condition, but these are not pathognomonic and exclusion of other inflammatory disorders including vasculitis is required. Wherever possible, a tissue diagnosis should be established. The characteristic histopathological changes include a lymphoplasmacytoid infiltrate, storiform fibrosis and obliterative phlebitis. IgG4-RD typically responds well to treatment with glucocorticoids, although relapse is relatively common and treatment with a steroid-sparing agent or rituximab may be required. Improved understanding of the pathogenesis of IgG4-RD is likely to lead to the development of more specific disease treatments in the future.
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Affiliation(s)
| | - Alina Casian
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Harsha Gunawardena
- Department of Rheumatology, Brunel Building, Southmead Hospital, Bristol, UK
- Musculoskeletal Research Unit, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - David D'Cruz
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
- Division of Immunology, Infection and Inflammatory Diseases, King's College London, New Hunt's House, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Claire M Rice
- School of Clinical Sciences, Level 1, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Department of Neurology, Brunel Building, Southmead Hospital, Bristol, UK.
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