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Cerne D, Losa M, Mattioli P, Lechiara A, Rebella G, Roccatagliata L, Arnaldi D, Schenone A, Morbelli S, Benedetti L, Massa F. Incident anti-LGI1 autoimmune encephalitis during dementia with Lewy bodies: when Occam razor is a double-edged sword. J Neuroimmunol 2024; 387:578291. [PMID: 38237526 DOI: 10.1016/j.jneuroim.2024.578291] [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: 12/04/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
Abstract
In Dementia with Lewy bodies (DLB), rapid cognitive decline and seizures seldom complicate the typical clinical course. Nevertheless, concurrent, treatable conditions may be responsible. We report a case of DLB with superimposed anti-LGI1 encephalitis, emphasizing the importance of thorough diagnostic reasoning beyond the simplest explanation amid distinct clinical cues.
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Affiliation(s)
- Denise Cerne
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mattia Losa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anastasia Lechiara
- Autoimmunity Laboratory, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giacomo Rebella
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Wang S, Hou H, Tang Y, Zhang S, Wang G, Guo Z, Zhu L, Wu J. An overview on CV2/CRMP5 antibody-associated paraneoplastic neurological syndromes. Neural Regen Res 2023; 18:2357-2364. [PMID: 37282453 PMCID: PMC10360094 DOI: 10.4103/1673-5374.371400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paraneoplastic neurological syndrome refers to certain malignant tumors that have affected the distant nervous system and caused corresponding dysfunction in the absence of tumor metastasis. Patients with this syndrome produce multiple antibodies, each targeting a different antigen and causing different symptoms and signs. The CV2/collapsin response mediator protein 5 (CRMP5) antibody is a major antibody of this type. It damages the nervous system, which often manifests as limbic encephalitis, chorea, ocular manifestation, cerebellar ataxia, myelopathy, and peripheral neuropathy. Detecting CV2/CRMP5 antibody is crucial for the clinical diagnosis of paraneoplastic neurological syndrome, and anti-tumor and immunological therapies can help to alleviate symptoms and improve prognosis. However, because of the low incidence of this disease, few reports and no reviews have been published about it so far. This article intends to review the research on CV2/CRMP5 antibody-associated paraneoplastic neurological syndrome and summarize its clinical features to help clinicians comprehensively understand the disease. Additionally, this review discusses the current challenges that this disease poses, and the application prospects of new detection and diagnostic techniques in the field of paraneoplastic neurological syndrome, including CV2/CRMP5-associated paraneoplastic neurological syndrome, in recent years.
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Affiliation(s)
- Sai Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yao Tang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shuang Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Gege Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ziyan Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lina Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Yamahara N, Kimura A, Shimohata T. [Autoimmune encephalitis and paraneoplastic neurological syndromes presenting atypical parkinsonism: a scoping review]. Rinsho Shinkeigaku 2023; 63:497-504. [PMID: 37518015 DOI: 10.5692/clinicalneurol.cn-001871] [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: 08/01/2023]
Abstract
Recent studies have demonstrated that atypical parkinsonism can be presented in autoimmune encephalitis and paraneoplastic neurological syndromes. However, it is unclear which anti-neural antibodies are involved and when these diseases should be suspected. To address these clinical questions, we conducted a scoping review and analyzed 38 articles. The literature shows that many anti-neural antibodies, including unknown ones, have been reported in progressive supranuclear palsy, corticobasal syndrome, and multiple system atrophy. Moreover, the following symptoms and signs suggest the possibility of autoimmune encephalitis and paraneoplastic neurological syndromes: early onset, acute or subacute progression, the presence of a neoplasm, significant weight loss, abnormal cerebrospinal fluid findings, the absence of typical brain magnetic resonance imaging findings, and the existence of atypical physical examination signs.
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Affiliation(s)
- Naoki Yamahara
- Department of Neurology, Gifu University Graduate School of Medicine
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine
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Elevated Hippocampal CRMP5 Mediates Chronic Stress-Induced Cognitive Deficits by Disrupting Synaptic Plasticity, Hindering AMPAR Trafficking, and Triggering Cytokine Release. Int J Mol Sci 2023; 24:ijms24054898. [PMID: 36902337 PMCID: PMC10003309 DOI: 10.3390/ijms24054898] [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: 02/08/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Chronic stress is a critical risk factor for developing depression, which can impair cognitive function. However, the underlying mechanisms involved in chronic stress-induced cognitive deficits remain unclear. Emerging evidence suggests that collapsin response mediator proteins (CRMPs) are implicated in the pathogenesis of psychiatric-related disorders. Thus, the study aims to examine whether CRMPs modulate chronic stress-induced cognitive impairment. We used the chronic unpredictable stress (CUS) paradigm to mimic stressful life situations in C57BL/6 mice. In this study, we found that CUS-treated mice exhibited cognitive decline and increased hippocampal CRMP2 and CRMP5 expression. In contrast to CRMP2, CRMP5 levels strongly correlated with the severity of cognitive impairment. Decreasing hippocampal CRMP5 levels through shRNA injection rescued CUS-induced cognitive impairment, whereas increasing CRMP5 levels in control mice exacerbated memory decline after subthreshold stress treatment. Mechanistically, hippocampal CRMP5 suppression by regulating glucocorticoid receptor phosphorylation alleviates chronic stress-induced synaptic atrophy, disruption of AMPA receptor trafficking, and cytokine storms. Our findings show that hippocampal CRMP5 accumulation through GR activation disrupts synaptic plasticity, impedes AMPAR trafficking, and triggers cytokine release, thus playing a critical role in chronic stress-induced cognitive deficits.
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Mulroy E, Balint B, Bhatia KP. Homer-3 Antibody Disease: A Potentially Treatable MSA-C Mimic. Mov Disord Clin Pract 2022; 9:178-182. [PMID: 35146057 PMCID: PMC8810419 DOI: 10.1002/mdc3.13404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eoin Mulroy
- Department of clinical and movement neurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Bettina Balint
- Department of Neurology, University Hospital ZürichUniversity of ZürichZürichSwitzerland
| | - Kailash P. Bhatia
- Department of clinical and movement neurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
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Hamidi S, Kafaie M, Gasimova U. DOPA-Responsive Tremor Associated With Gammopathy: A Case Report and Literature Review. Cureus 2021; 13:e19963. [PMID: 34984123 PMCID: PMC8714039 DOI: 10.7759/cureus.19963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/05/2022] Open
Abstract
Tremors have been well-described in association with monoclonal gammopathy. We report a case of a patient with asymmetric hands tremor who responded well to levodopa-carbidopa treatment. Further workup showed an underlying gammopathy. To our knowledge, this is one of the rarest case reports of successful treatment of gammopathy-related tremors with levodopa-carbidopa. The patient was a 75-year-old male who presented to the neurology clinic for a one-year history of worsening tremors in bilateral upper extremities. A review of systems was only remarkable for mild numbness and tingling in his feet. His neurological examination was remarkable for asymmetric right more than left (R > L) resting and kinetic tremor in both upper extremities associated with mild rigidity and bradykinesia in right upper extremity and decreased bilateral ankle jerks. With the primary diagnosis of Parkinson’s disease, he was started on levodopa-carbidopa and a neuropathy workup was requested. His follow-up visit after three months was remarkable for significant improvement of his tremors with carbidopa-levodopa. However, his blood work was consistent with a significant increase in lambda light chain levels and the presence of an M spike in serum protein electrophoresis. Based on the presentation and clinical workup, he was finally found to have both multiple myeloma and Waldenstrom’s macroglobulinemia. Underlying malignancy was treated with chemotherapy and immunotherapy. Levodopa-carbidopa was discontinued after three months of chemotherapy and his tremor did not recur in one year of follow-up. Gammopathy is one of the well-known causes of tremors in the adult population. It can cause both resting and kinetic tremors in the upper extremities. It is supposed that peripheral neuropathy associated with gammopathy is the main underlying cause of tremors in these groups of patients. However, central causes are also suggested. In this case, we are led to conclude that our patient’s tremor was centrally mediated since it responded well to dopamine replacement therapy. However, further study is needed to elucidate the role of dopamine depletion in the pathogenesis of tremors associated with gammopathies.
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Song J, Zhang Y, Lang Y, Wang YH, Shao J, Cui L. Parkinsonism and dysautonomia with anti-CV2/CRMP5 associated paraneoplastic neurological syndromes mimicking multiple system atrophy: a case report. BMC Neurol 2021; 21:408. [PMID: 34702214 PMCID: PMC8547084 DOI: 10.1186/s12883-021-02448-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Paraneoplastic neurological syndromes (PNSs) are broad-spectrum disorders that can affect any part of the nervous system varying in core symptoms. Onconeural antibodies, including Hu, Yo, Ri, anti-CV2, amphiphysin, Ma2, and Tr are well-characterized and commonly used for the diagnosis of definite PNS. Generally, anti-CV2 antibodies have usually been associated with cerebellar ataxia, chorea, peripheral and autonomic neuropathies, myelopathy, optic neuritis, and retinitis. However, Parkinsonism has not been reported as the core symptom in patients with anti-CV2 antibodies. Case presentation We report a patient with anti-CV2 antibody manifested as Parkinsonism and autonomic dysfunction, which may lead to the diagnosis of multiple system atrophy with predominant Parkinsonism (MSA-P). A lumbar puncture examination was undergone to find a positive anti-CV2 antibody in cerebrospinal fluid. PET-CT showed no tumor. Immunotherapy was adopted and the symptoms were relieved for 5 months. However, with no evidence of tumor, he died after 8 months. Conclusions Our findings indicate that PNS with anti-CV2 antibody can be shown as MSA-P mimic. Considering that MSA is a neurodegenerative disease with a poor prognosis, screening for other treatable or controllable factors like PNS presented in this case is necessary when encountering a rapid progressive MSA-mimic patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02448-6.
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Affiliation(s)
- Jia Song
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China
| | - Ying Zhang
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China
| | - Yue Lang
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China
| | - Yi-Heng Wang
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China
| | - Jie Shao
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China
| | - Li Cui
- Department of Neurology, Jilin University First Hospital, Xinmin Street 1, Changchun, Jilin, China.
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8
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Franco G, Lazzeri G, Di Fonzo A. Parkinsonism and ataxia. J Neurol Sci 2021; 433:120020. [PMID: 34711421 DOI: 10.1016/j.jns.2021.120020] [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: 05/19/2021] [Revised: 08/09/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022]
Abstract
Ataxia is not a common feature in Parkinson's disease. Nevertheless, some rare forms of parkinsonism have ataxia as one of the main features in their clinical picture, especially those with juvenile or early-onset. On the other side, in cerebellar degenerative diseases, parkinsonism might accompany the typical symptoms and even become predominant in some cases. Many disorders involving different neurological systems present with a movement phenomenology reflecting the underlying pattern of pathological involvement, such as neurodegeneration with brain iron accumulation, neurodegeneration associated with calcium deposition, and metabolic and mitochondrial disorders. The prototype of sporadic disorders that present with a constellation of symptoms due to the involvement of multiple Central Nervous System regions is multiple system atrophy, whose motor symptoms at onset can be cerebellar ataxia or parkinsonism. Clinical syndromes encompassing both parkinsonian and cerebellar features might represent a diagnostic challenge for neurologists. Recognizing acquired and potentially treatable causes responsible for complex movement disorders is of paramount importance, since an early diagnosis is essential to prevent permanent consequences. The present review aims to provide a pragmatic overview of the most common diseases characterized by the coexistence of cerebellar and parkinsonism features and suggests a possible diagnostic approach for both inherited and sporadic disorders. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Giulia Franco
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Giulia Lazzeri
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.
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9
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Tatsumi S, Uryu K, Iwasaki S, Harada H. A Case of Anti-CRMP5 Paraneoplastic Neurological Syndrome Induced by Atezolizumab for Small Cell Lung Cancer. Intern Med 2020. [PMID: 32788536 DOI: 10.2169/internalmedicine.4889-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 76-year-old man who developed irritability and forgetfulness 5 months after the introduction of atezolizumab for the treatment of small cell lung cancer (SCLC). Brain magnetic resonance imaging showed lesions of the striatum, and an investigation of the serum revealed a high titer of anti-CRMP5 antibody. After stopping atezolizumab and starting steroid pulse therapy, these clinical features improved. Given these findings, it is considered that CRMP5-assciated striatal encephalitis was induced by atezolizumab in this case with SCLC.
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Affiliation(s)
| | - Kiyoaki Uryu
- Department of Oncology, Tokushukai General Hospital, Japan
- Department of Respiratory Medicine, Tokushukai General Hospital, Japan
| | - Satoru Iwasaki
- Department of Radiology, Tokushukai General Hospital, Japan
| | - Hiromasa Harada
- Department of Respiratory Medicine, Tokushukai General Hospital, Japan
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10
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Kiernan MC, Cornblath DR. Subacute sensory neuronopathy and cancer: the identification of paraneoplastic syndromes. J Neurol Neurosurg Psychiatry 2020; 91:793-794. [PMID: 32245767 DOI: 10.1136/jnnp-2020-323171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia .,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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11
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Takkar A, Mehta S, Gupta N, Bansal S, Lal V. Anti- RI antibody associated progressive supranuclear palsy like presentation in a patient with breast carcinoma. J Neuroimmunol 2020; 347:577345. [PMID: 32763584 DOI: 10.1016/j.jneuroim.2020.577345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/27/2022]
Abstract
Paraneoplastic neurological syndromes (PNS) are well established entities associated with onconeural antibodies. Paraneoplastic parkinsonism is a highly under narrated presentation of PNS. Rapid progression of typical or atypical parkinsonism with red flags like multiaxial involvement, complete gaze palsy and a clinico-radiological mismatch should prompt a clinician to suspect secondary etiologies like infection, metabolic, vascular, metastatic and paraneoplastic causes. We describe a patient with rapidly progressive parkinsonism. Diagnosis of Breast carcinoma associated ANNA-2/ Anti Ri mediated PSP like phenotype was made in this patient based upon clinical examination and investigations. We also present a review of literature on paraneoplastic parkinsonism in this manuscript.
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Affiliation(s)
- Aastha Takkar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012,.
| | - Sahil Mehta
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012,.
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research Chandigarh, 160012,.
| | - Saurabh Bansal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012,.
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012,.
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12
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Vakrakou A, Constantinides VC, Velonakis G, Tzartos JS, Stefanis L, Kapaki E, Paraskevas GP. Paraneoplastic basal ganglia encephalitis associated with anti-CV2/CRMP-5 and anti-Yo antibodies in a patient with non-small-cell lung cancer. Neurol Sci 2020; 41:2649-2651. [PMID: 32307664 DOI: 10.1007/s10072-020-04399-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Aigli Vakrakou
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Vasilios C Constantinides
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece.
| | - George Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John S Tzartos
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece.,Tzartos NeuroDiagnostics, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George P Paraskevas
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Medical School, 72 Vas. Sofias Ave, 11528, Athens, Greece
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How to approach a patient with parkinsonism - red flags for atypical parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:1-34. [PMID: 31779810 DOI: 10.1016/bs.irn.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinsonism is a clinical syndrome defined by bradykinesia plus rigidity or tremor. Though most commonly encountered in the setting of idiopathic Parkinson's disease, a number of neurodegenerative, structural, metabolic and toxic neurological disorders can result in parkinsonism. Accurately diagnosing the underlying cause of parkinsonism is of both therapeutic and prognostic relevance, especially as we enter the era of disease-modifying treatment trials for neurodegenerative disorders. Being aware of the wide array of potential causes of parkinsonism is of paramount importance for clinicians. In this chapter, we present a pragmatic clinical approach to patients with parkinsonism, specifically focusing on 'red flags', which should alert one to consider diagnoses other than idiopathic Parkinson's disease.
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Wu X, Wang H, Xu G, Lin Y. Anti-CV2 Autoimmune Encephalitis With Parkinson-Like Symptoms and Bilateral Leukoencephalopathy-A Case Report. Front Neurol 2019; 10:1064. [PMID: 31649611 PMCID: PMC6794459 DOI: 10.3389/fneur.2019.01064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023] Open
Abstract
Objective: To present a patient with anti-CV2 autoimmune encephalitis admitted for Parkinson-like symptoms and bilateral leukoencephalopathy. Case report: The patient was admitted for Parkinson-like symptoms combined with loss of taste. Serum anti-CV2 antibody was positive. Cranial magnetic resonance imaging revealed bilateral leukoencephalopathy. Breast cancer was detected by positron emission tomography (PET) and ultrasound. Immunotherapy was not performed. Modified radical mastectomy revealed a pT1cN0M0 breast cancer, positive for estrogen and progesterone receptors, and HER2 negative. The resting tremors disappeared by 1 week after surgery. The modified Rankin score (mRS) was four before surgery, and decreased to one at 9 months after surgery. Conclusion: Anti-CV2 autoimmune encephalitis can present as Parkinsonism with bilateral leukoencephalopathy on MRI. PET scanning can be useful to reveal an occult cancer. Treatment of the cancer may improve the paraneoplastic neurological syndrome without the need of immunosuppressive therapy.
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Affiliation(s)
- Xuan Wu
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huayan Wang
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guorong Xu
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu Lin
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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15
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Barba C, Alexopoulos H. Parkinsonism in autoimmune diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:419-452. [DOI: 10.1016/bs.irn.2019.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Ricigliano VAG, Fossati B, Saraceno L, Cavalli M, Bazzigaluppi E, Meola G. MSA Mimic? Rare Occurrence of Anti-Hu Autonomic Failure and Thymoma in a Patient with Parkinsonism: Case Report and Literature Review. Front Neurosci 2018; 12:17. [PMID: 29416500 PMCID: PMC5787932 DOI: 10.3389/fnins.2018.00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
Thymoma is a tumor originating from thymic gland, frequently manifesting with paraneoplastic neurological disorders. Its association with paraneoplastic dysautonomia is relatively uncommon. Here, we describe the challenging case of a 71 year-old female who developed subacute autonomic failure with digestive pseudo-obstruction, dysphagia, urinary tract dysfunction and orthostatic hypotension complicating an underlying extrapyramidal syndrome that had started 3 months before hospital admission. Autonomic symptoms had 2-month course and acutely worsened just before and during hospitalization. Combination of severe dysautonomia and parkinsonism mimicked rapidly progressing multiple system atrophy. However, diagnostic exams showed thymic tumor with positive anti-Hu antibodies on both serum and cerebrospinal fluid. Complete response of dysautonomia to immunoglobulins followed by thymectomy confirmed the diagnosis of anti-Hu-related paraneoplastic neurological syndrome. With regards to extrapyramidal symptoms, despite previous descriptions of paraneoplastic parkinsonism caused by other antineuronal antibodies, in our case no relation between anti-Hu and parkinsonism could be identified. A literature review of published reports describing anti-Hu positivity in thymic neoplasms highlighted that a definite autonomic disease due to anti-Hu antibodies is extremely rare in patients with thymoma but without myasthenia gravis, with only one case published so far.
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Affiliation(s)
- Vito A G Ricigliano
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Barbara Fossati
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Lorenzo Saraceno
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele Cavalli
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Elena Bazzigaluppi
- Autoimmunity Service, Laboratory Medicine, San Raffaele Hospital, Milan, Italy
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.,Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
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17
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Nabil A, Houyam T, Adil B, Jawad O, Ahmed B. Severe Paraneoplastic Parkinsonism: A Rare Cause Revealing Breast Cancer. J Clin Neurol 2017; 13:310-311. [PMID: 28748681 PMCID: PMC5532334 DOI: 10.3988/jcn.2017.13.3.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Abida Nabil
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Tibar Houyam
- Research Team in Neurology and Neurogenetics, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco.,Neurology B and Neurogenetics Department, Hôpital des Spécialités ONO, CHU Ibn Sina, Rabat, Morocco.
| | - Boudhas Adil
- Pathology Unit, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Oumerzouk Jawad
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
| | - Bourazza Ahmed
- Department of Neurology, Hôpital Militaire d'instruction Mohamed V, Mohamed V-Souissi University, Rabat, Morocco
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18
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Yap SM, Lynch T, MacMahon P, Murray B. Paraneoplastic Atypical Parkinsonism with Anti-CRMP5 Antibodies and Severe Caudate and Putaminal Hypometabolism on 18-Fluorodeoxyglucose Positron Emission Tomography of the Brain. Mov Disord Clin Pract 2016; 4:263-265. [PMID: 30838264 DOI: 10.1002/mdc3.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/25/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Siew Mei Yap
- Department of Neurology Mater Misericordiae University Hospital Dublin Ireland
| | - Tim Lynch
- Department of Neurology Mater Misericordiae University Hospital Dublin Ireland
| | - Peter MacMahon
- Department of Radiology Mater Misericordiae University Hospital Dublin Ireland
| | - Brian Murray
- Department of Neurology Mater Misericordiae University Hospital Dublin Ireland
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