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Thakolwiboon S, Linnoila J, Pittock SJ, Dubey D, Zekeridou A. Cerebellar leptomeningeal enhancement: An imaging finding of rapidly progressive Purkinje cell cytoplasmic autoantibody type 1 paraneoplastic cerebellar syndrome. J Neuroimmunol 2024; 387:578293. [PMID: 38266443 DOI: 10.1016/j.jneuroim.2024.578293] [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: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Purkinje cell cytoplasmic autoantibody type 1 (PCA1), also known as anti-Yo, is a 'high-risk' paraneoplastic antibody, associated with rapidly progressive cerebellar syndrome. In patients with this syndrome, various MRI abnormalities have been documented, including atrophy in the cerebellum and brainstem, T2 hyperintensity in the brainstem and spinal cord, and cranial nerve enhancement. This report introduces an imaging finding, cerebellar leptomeningeal enhancement, which was observed in all three cases at early stages. Despite neurological deterioration, all patients underwent immunotherapy, and subsequent follow-up MRI revealed resolution of the leptomeningeal enhancement, suggesting that this feature is distinct from meningeal carcinomatosis.
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Affiliation(s)
- Smathorn Thakolwiboon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Neurology, Mayo Clinic Health System Franciscan Health Care, La Crosse, WI, United States of America; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America.
| | - Jenny Linnoila
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
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Mendes NT, Ronchi NR, Silva GD. A Systematic Review on Anti-Yo/PCA-1 Antibody: Beyond Cerebellar Ataxia in Middle-Aged Women with Gynecologic Cancer. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1287-1292. [PMID: 36334195 DOI: 10.1007/s12311-022-01492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Current understanding of anti-Yo/PCA1 antibody-associated cerebellar ataxia is based on case reports and small case series. Our goal was to summarize clinical features, highlighting atypical presentations and gaps of knowledge. Following the PRISMA guidelines, we systematically screened Pubmed/MEDLINE, Embase, Scopus, and Web of Science from inception to April 2022 for all case reports and series concerning anti-Yo antibody-associated cerebellar ataxia. We collected data on clinical presentation, investigation findings, and treatment outcomes. Of 379 included patients, 96% were female with gynecologic cancer (82%). Among men, 87% had an associated tumor, mainly of gastrointestinal origin. The median age was 60 years old. Pancerebellar ataxia was the main clinical feature, but extracerebellar findings were frequent during the disease course. Vertigo and imbalance can be present early in the disease course in about two thirds of patients, as a prodromal phase. Although neuroimaging usually is normal or shows cerebellar atrophy, inflammatory changes may also be present. More than half of the patients reported some improvement after immunotherapy. However, despite treatment, 84% of survivors were unable to walk unassisted on follow-up. Our study provides objective data and advances in current knowledge of anti-Yo antibody-associated cerebellar ataxia such as the description of prodromal symptoms, extracerebellar findings, and its presentations in males.
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Affiliation(s)
- Natalia Trombini Mendes
- Neuroimmunology Group, Department of Neurology, University of São Paulo, Avenida Dr Enéas de Carvalho Aguiar, CEP 05403-000, São Paulo, 255, Brazil.
| | - Nathalia Rossoni Ronchi
- Neuroimmunology Group, Department of Neurology, University of Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Group, Department of Neurology, University of São Paulo, Avenida Dr Enéas de Carvalho Aguiar, CEP 05403-000, São Paulo, 255, Brazil
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Sakoda M, Sarhadi K, Weisner PA, Tierney S, Wang Y. Clinical Reasoning: A 67-Year-Old Woman With Progressive Diplopia, Vertigo, and Ataxia. Neurology 2021; 98:e669-e674. [PMID: 34862319 DOI: 10.1212/wnl.0000000000013141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vogrig A, Bernardini A, Gigli GL, Corazza E, Marini A, Segatti S, Fabris M, Honnorat J, Valente M. Stroke-Like Presentation of Paraneoplastic Cerebellar Degeneration: a Single-Center Experience and Review of the Literature. CEREBELLUM (LONDON, ENGLAND) 2019; 18:976-982. [PMID: 31463826 DOI: 10.1007/s12311-019-01075-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paraneoplastic cerebellar degeneration (PCD) is usually thought to have a subacute progression over several weeks. We report herein incidence and clinical features of hyperacute onset PCD, a vertebrobasilar stroke mimic. We performed a retrospective analysis of all suspected PCD cases referred to the Udine University Hospital between 2009 and 2017. Our center provides the only neuroimmunology laboratory for three provinces of the Friuli-Venezia Giulia region, Italy (983,190 people as of January 1, 2017). Inclusion criteria were (1) abrupt onset of neurological symptoms; (2) initial consideration of a vascular etiology; (3) final diagnosis of "definite PCD." We also carried out a systematic review of the literature in order to identify previous stroke-like PCD cases. Between 2009 and 2017, 24 patients received a final diagnosis of PCD. The age-standardized incidence rate of PCD was 0.22/100,000 person-years. Two cases (8.3%) had a stroke-like onset, with an incidence of 0.02/100,000 person-years. Additionally, 10 previously reported stroke-like PCD cases were identified. Among all cases (n = 12), 67% were female; median age was 51 years (range, 22-69). An associated cancer was discovered in all cases. Brain imaging was normal in most (75%) of the patients. Cerebrospinal fluid (CSF) analysis showed inflammatory alterations in 73% of the cases. Cancer treatment was more effective than immunotherapy in improving the neurological syndrome. Typical patients with hyperacute PCD are middle-aged women with normal brain imaging, inflammatory markers in CSF, and cancer. Surgery of the underlying cancer is probably the best treatment. PCD must be considered in the differential diagnosis of acute-onset ataxia and/or vertigo.
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Affiliation(s)
- Alberto Vogrig
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon University Hospital, Lyon, France.
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France.
- University Claude Bernard Lyon 1, University of Lyon, Lyon, France.
| | - Andrea Bernardini
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
- Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Elisa Corazza
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Alessandro Marini
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Samantha Segatti
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Department of Laboratory Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon University Hospital, Lyon, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Mariarosaria Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy
- Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
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Le May M, Dent S. Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration associated with cognitive affective syndrome in a patient with breast cancer: a case report and literature review. ACTA ACUST UNITED AC 2018; 25:e585-e591. [PMID: 30607127 DOI: 10.3747/co.25.4106] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women, with 15%-25% of those tumours overexpressing the human epidermal growth factor receptor 2 (her2), which is associated with more aggressive disease. On rare occasions, patients present with a paraneoplastic syndrome months to years before their cancer diagnosis. Paraneoplastic cerebellar degeneration (pcd) is associated with fewer than 1% of cancers and is strongly associated with breast and gynecologic malignancies. Anti-Yo antibody is the antibody most frequently identified with the syndrome, and it is associated with a very poor prognosis. Recent studies have implicated a relationship between overexpression of her2 and anti-Yo-mediated pcd. Current pcd treatments include tumour removal, chemotherapy, targeted therapy, and immune-suppressive treatments. Outcomes of pcd are typically poor, and no guidelines for treatment currently exist. Early recognition followed by rapid initiation of treatment remains the cornerstone of therapy. Here, we present a case of anti-Yo-antibody pcd secondary to estrogen and progesterone receptor-negative, her2-positive breast cancer. Despite treatment with mastectomy, chemotherapy, and her2-targeted therapy, no significant neurologic improvement was achieved, and cerebellar cognitive affective syndrome subsequently developed.
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Affiliation(s)
- M Le May
- Department of Medicine, University of Ottawa, Ottawa, ON
| | - S Dent
- Department of Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON
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