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Oprea E, Elosegi JA. Autoimmune GFAP-IgG astrocytopathy manifesting with acute cerebellitis and severe gastrointestinal symptoms. Rev Neurol (Paris) 2023; 179:1147-1151. [PMID: 37858434 DOI: 10.1016/j.neurol.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 10/21/2023]
Affiliation(s)
- E Oprea
- Neurology department, Cliniques Universitaires Saint Luc, Bruxelles, Belgique.
| | - J A Elosegi
- Neurology department, CHU Ambroise-Paré, Mons, Belgique
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Li W, He L, Jin X, Li L, Sun C, Wang C. Isolated dysarthria as the sole manifestation of myasthenia gravis: a case report. J Int Med Res 2022; 50:3000605221109395. [PMID: 35915860 PMCID: PMC9350514 DOI: 10.1177/03000605221109395] [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] [Indexed: 11/16/2022] Open
Abstract
Myasthenia gravis (MG) is an acquired autoimmune disease. Its clinical
manifestations comprise ptosis, diplopia, dysarthria, dysphagia, limb weakness,
and in severe cases, respiratory muscle involvement. Dysarthria as an exclusive
initial and primary complaint in MG is rare and seldom reported. In this paper,
we report a case of type IIIb MG with isolated dysarthria as the only clinical
manifestation and we review the relevant literature. The patient was a
62-year-old man who presented with episodes of slurred speech for 20 days that
had worsened in the previous 9 days. His medical history comprised hypertension,
diabetes mellitus, and coronary heart disease. The initial diagnosis on
admission was transient ischemic attack. Careful re-examination of the patient’s
history revealed that his symptoms mainly involved increasingly worse slurred
speech episodes without drinking or swallowing difficulties, and no significant
improvement with rest was observed. Electromyography and autoantibody profiling
led to a diagnosis of type IIIb MG. His symptoms improved after the oral
administration of pyridostigmine bromide 60 mg. Laryngeal MG is important to
differentiate from stroke. It is necessary to perform a computerized voice
analysis when encountering patients with atypical symptoms of MG.
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Affiliation(s)
- Wei Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Ling He
- Department of Neurology, Jilin Central General Hospital, Jilin, China
| | - Xiaodong Jin
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Li Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Congcong Sun
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cuilan Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Banks SA, Morris PP, Chen JJ, Pittock SJ, Sechi E, Kunchok A, Tillema JM, Fryer JP, Weinshenker BG, Krecke KN, Lopez-Chiriboga AS, Nguyen A, Greenwood TM, Lucchinetti CF, Zalewski NL, Messina SA, Flanagan EP. Brainstem and cerebellar involvement in MOG-IgG-associated disorder versus aquaporin-4-IgG and MS. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-325121. [PMID: 33372052 PMCID: PMC8592388 DOI: 10.1136/jnnp-2020-325121] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the frequency and characteristics of brainstem or cerebellar involvement in myelin-oligodendrocyte-glycoprotein-antibody-associated-disorder (MOGAD) versus aquaporin-4-IgG-seropositive-neuromyelitis optica spectrum disorder (AQP4-IgG-NMOSD) and multiple sclerosis (MS). METHODS In this observational study, we retrospectively identified 185 Mayo Clinic MOGAD patients with: (1) characteristic MOGAD phenotype, (2) MOG-IgG seropositivity by live cell-based assay and (3) MRI lesion(s) of brainstem, cerebellum or both. We compared the symptomatic attacks to AQP4-IgG-NMOSD (n=30) and MS (n=30). RESULTS Brainstem or cerebellar involvement occurred in 62/185 (34%) MOGAD patients of which 39/62 (63%) were symptomatic. Ataxia (45%) and diplopia (26%) were common manifestations. The median age in years (range) in MOGAD of 24 (2-65) was younger than MS at 36 (16-65; p=0.046) and AQP4-IgG-NMOSD at 45 (6-72; p=0.006). Isolated attacks involving the brainstem, cerebellum or both were less frequent in MOGAD (9/39 (23%)) than MS (22/30 (73%); p<0.001) but not significantly different from AQP4-IgG-NMOSD (14/30 (47%); p=0.07). Diffuse middle cerebellar peduncle MRI-lesions favoured MOGAD (17/37 (46%)) over MS (3/30 (10%); p=0.001) and AQP4-IgG-NMOSD (3/30 (10%); p=0.001). Diffuse medulla, pons or midbrain MRI lesions occasionally occurred in MOGAD and AQP4-IgG-NMOSD but never in MS. Cerebrospinal fluid (CSF) oligoclonal bands were rare in MOGAD (5/30 (17%)) and AQP4-IgG-NMOSD (2/22 (9%); p=0.68) but common in MS (18/22 (82%); p<0.001). Disability at nadir or recovery did not differ between the groups. CONCLUSION Involvement of the brainstem, cerebellum or both is common in MOGAD but usually occurs as a component of a multifocal central nervous system attack rather than in isolation. We identified clinical, CSF and MRI attributes that can help discriminate MOGAD from AQP4-IgG-NMOSD and MS.
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Affiliation(s)
| | - Padraig P Morris
- Radiology (Division of Neuroradiology), Mayo Clinic, Rochester, Minnesota, USA
| | - John J Chen
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Ophthalmology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sean J Pittock
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elia Sechi
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Clinical and Experimental Medicine, Sassari University Hospital, Sassari, Sardegna, Italy
| | - Amy Kunchok
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Neurology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - James P Fryer
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karl N Krecke
- Radiology (Division of Neuroradiology), Mayo Clinic, Rochester, Minnesota, USA
| | | | - Adam Nguyen
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tammy M Greenwood
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Steven A Messina
- Radiology (Division of Neuroradiology), Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Zhang Q, Li Y, Liu R, Huang D, Wu L, Yu S. Paroxysmal dysarthria-ataxia syndrome: Literature review on MRI findings and report of a peculiar case with clinically isolated syndrome coexisting with anti-N-methyl-d-aspartate receptor antibodies. J Neuroimmunol 2020; 347:577327. [PMID: 32721556 DOI: 10.1016/j.jneuroim.2020.577327] [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: 04/23/2020] [Revised: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
Paroxysmal dysarthria and ataxia (PDA) syndrome constitutes a rare neurological disorder, and is generally reported in cases of multiple sclerosis (MS) involving the midbrain. We present an illustrative case of 32-year-old female who developed clinically isolated syndrome manifested paroxysmal dysarthria, ataxia, ptosis and diplopia, coexisting with anti-N-methyl-d-aspartate receptor antibodies. We review the literature and identify 23 other cases with brain MRI examinations to summarize the lesion locations and clinical characteristics of PDA syndrome, and ultimately provide a new framework for understanding this rare condition. The current case expands the spectrum of symptoms in PDA syndrome, which was including but not limited to dysarthria and ataxia. Caudal paramedian midbrain lesions involving decussation of the superior cerebellar peduncles appear to be critical for PDA syndrome.
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Affiliation(s)
- Qingkui Zhang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China
| | - Yang Li
- School of Medicine, Nankai University, Tianjin 300071, PR China
| | - Ruozhuo Liu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China
| | - Dehui Huang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China
| | - Lei Wu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China,.
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China,.
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