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Shobatake R, Kumazawa A, Koyama N, Takahashi N. Autoimmune Encephalitis Associated with Anti-N-methyl-D-aspartate Receptor and Anti-Hu Antibodies Successfully Treated with Carboplatin and Etoposide for Small-cell Lung Cancer. Intern Med 2023; 62:469-474. [PMID: 35768218 PMCID: PMC9970802 DOI: 10.2169/internalmedicine.9707-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The coexistence of multiple autoantibodies associated with autoimmune encephalitis (AE) is rare. A 63-year-old woman developed psychosis and consciousness disorder. Her cerebrospinal fluid was positive for anti-N-methyl-D-aspartate receptor antibodies, and her serum was positive for anti-Hu antibodies. Enhanced computed tomography revealed a mass in the right pulmonary hilum. AE complicated with small-cell lung cancer was diagnosed. Immunotherapy (steroid therapy and intravenous immunoglobulin) and four courses of carboplatin-etoposide chemotherapy were required to improve her neurological symptoms. When the coexistence of multiple antibodies is detected, despite its rarity, aggressive detection and treatment of any underlying malignancy may be recommended.
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Affiliation(s)
| | - Aya Kumazawa
- Department of Neurology, Nara City Hospital, Japan
| | - Noriko Koyama
- Department of Respiratory Medicine, Nara City Hospital, Japan
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Sun Y, Koyama Y, Shimada S. Inflammation From Peripheral Organs to the Brain: How Does Systemic Inflammation Cause Neuroinflammation? Front Aging Neurosci 2022; 14:903455. [PMID: 35783147 PMCID: PMC9244793 DOI: 10.3389/fnagi.2022.903455] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
As inflammation in the brain contributes to several neurological and psychiatric diseases, the cause of neuroinflammation is being widely studied. The causes of neuroinflammation can be roughly divided into the following domains: viral infection, autoimmune disease, inflammation from peripheral organs, mental stress, metabolic disorders, and lifestyle. In particular, the effects of neuroinflammation caused by inflammation of peripheral organs have yet unclear mechanisms. Many diseases, such as gastrointestinal inflammation, chronic obstructive pulmonary disease, rheumatoid arthritis, dermatitis, chronic fatigue syndrome, or myalgic encephalomyelitis (CFS/ME), trigger neuroinflammation through several pathways. The mechanisms of action for peripheral inflammation-induced neuroinflammation include disruption of the blood-brain barrier, activation of glial cells associated with systemic immune activation, and effects on autonomic nerves via the organ-brain axis. In this review, we consider previous studies on the relationship between systemic inflammation and neuroinflammation, focusing on the brain regions susceptible to inflammation.
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Affiliation(s)
- Yuanjie Sun
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshihisa Koyama
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
- Addiction Research Unit, Osaka Psychiatric Research Center, Osaka Psychiatric Medical Center, Osaka, Japan
- *Correspondence: Yoshihisa Koyama, ; orcid.org/0000-0003-3965-0716
| | - Shoichi Shimada
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
- Addiction Research Unit, Osaka Psychiatric Research Center, Osaka Psychiatric Medical Center, Osaka, Japan
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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder. J Psychiatr Pract 2019; 25:222-226. [PMID: 31083037 DOI: 10.1097/pra.0000000000000390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.
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Kohutek F, Katrlik J, Bystricky B. Hypotension as a symptom of autonomic neuropathy in patients with advanced malignancies. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:331-334. [PMID: 30546151 DOI: 10.5507/bp.2018.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
AIMS Hypotension can be a symptom of paraneoplastic autonomic neuropathy (PAN). Onconeural antibodies (OA) provide strong evidence for the paraneoplastic origin of neurological syndromes. Our goal was to assess the frequency of PAN among patients with advanced malignancies and hypotension using OA. METHODS Patients with advanced malignancies and hypotension were screened and enrolled as per protocol. Plasma levels of six classical OAs were assessed in these patients. We prospectively evaluated other symptoms of PAN in these patients. RESULTS 31 patients out of 740 screened met the criteria of this cross-sectional study. OAs were present in 4 patients (12.9%). Anti-amphiphysin was found in 1 patient (3.23%), anti- CV2 (anti-CRPM5, anti- collapsin- response mediator protein) was present in 1 patient (3.23%), 1 patient (3.23%) was positive for anti-Hu and anti-Ma2 was present in 1 patient (3.23%). No patient was positive for 2 or more OAs. Normalization of blood pressure in concordance with partial remission occurred in 5 patients. The most used criteria for PAN were fulfilled in 9 patients. CONCLUSION The frequency of PAN may be underestimated in a busy oncology clinic. Assessing OAs may aid in the differential diagnosis of hypotension of unknown origin.
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Affiliation(s)
- Filip Kohutek
- Department of Oncology, Faculty Hospital Trencin, Legionarska 28, Trencin, Slovak Republic
| | - Jaroslav Katrlik
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava, Slovak Republic
| | - Branislav Bystricky
- Department of Oncology, Faculty Hospital Trencin, Legionarska 28, Trencin, Slovak Republic
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Targonska B, Frost J, Prabhu S. Anti-Ma2-antibody-associated encephalitis: An atypical paraneoplastic neurologic syndrome. SA J Radiol 2018; 22:1310. [PMID: 31754496 PMCID: PMC6837793 DOI: 10.4102/sajr.v22i1.1310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/03/2018] [Indexed: 01/24/2023] Open
Abstract
Paraneoplastic syndromes are a heterogeneous group of conditions affecting cancer patients, where the signs and symptoms are not owing to the local effects of the tumour but instead owing to humoral or immunologic effects. We describe an unusual presentation of a paraneoplastic neurologic syndrome presenting with predominant involvement of the hypothalamus and deep grey nuclei secondary to an anterior mediastinal germinoma and associated with anti-Ma2 antibody.
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Affiliation(s)
- Bogna Targonska
- Department of Radiology, Renown Regional Medical Center, Reno, NV, United States
| | - Jamie Frost
- Helen DeVos Childrens Hospital, Advanced Radiology Services, Grand Rapids, MI, United States
| | - Sanjay Prabhu
- Department of Radiology, Boston Children's Hospital, Boston, MA, United States
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Sæther SG, Schou M, Kondziella D. What is the significance of onconeural antibodies for psychiatric symptomatology? A systematic review. BMC Psychiatry 2017; 17:161. [PMID: 28468645 PMCID: PMC5415831 DOI: 10.1186/s12888-017-1325-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/24/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with intracellular onconeural antibodies may present with neuro-psychiatric syndromes. We aimed to evaluate the evidence for an association between well-characterized onconeural antibodies and psychiatric symptoms in patients with and without paraneoplastic central nervous system syndromes. METHODS Eligible studies were selected from 1980 until February 2017 according to standardized review criteria and evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). We included studies describing the psychiatric symptomatology of onconeural antibody positive patients and the prevalence of onconeural antibodies in patients with psychiatric disorders. RESULTS Twenty-seven studies met the inclusion criteria. Six studies reported on the prevalence of well-characterized onconeural antibodies in patients with different psychiatric disorders, ranging from 0% to 4.9%. Antibody prevalence in controls was available from three studies, ranging from 0% to 2.8%. Data heterogeneity precluded a meta-analysis. Two cerebrospinal fluid studies found well-characterized onconeural antibodies in 3.5% and 0% of patients with psychotic and depressive syndromes, respectively. CONCLUSIONS The available evidence suggests that the prevalence of well-characterized onconeural antibodies in patients with psychiatric disorders is generally low. However, the question whether onconeural antibodies are important in select patients with a purely psychiatric phenotype needs to be addressed by appropriately designed studies in the future.
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Affiliation(s)
- Sverre Georg Sæther
- Department of Psychiatry, St. Olav's University Hospital, Pb. 3008, Lade, 7441, Trondheim, Norway. .,Department of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491, Trondheim, Norway.
| | - Morten Schou
- 0000 0004 0627 3560grid.52522.32Department of Psychiatry, St. Olav’s University Hospital, Pb. 3008, Lade, 7441 Trondheim, Norway ,0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491 Trondheim, Norway
| | - Daniel Kondziella
- 0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491 Trondheim, Norway ,0000 0004 0646 7373grid.4973.9Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvei 9; DK, -2100 Copenhagen, Denmark
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Bentea G, Sculier C, Grigoriu B, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature: Part 3: Neurological paraneoplastic syndromes, involving the central nervous system. Lung Cancer 2017; 106:83-92. [PMID: 28285700 DOI: 10.1016/j.lungcan.2017.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the third of a series of five and deals mainly with neurological paraneoplastic syndromes involving the central nervous system.
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Affiliation(s)
- Georgiana Bentea
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Claudine Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium.
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Boujoual M, Hakimi I, Kassidi F, Akhoudad Y, Sahel N, Rkiouak A, Allaoui M, Chahdi H, Oukabli M, Kouach J, Moussaoui DR, Dehayni M. Paraneoplastic syndromes revealing ovarian teratoma in young and menopausal women: report of two cases. Pan Afr Med J 2016; 24:161. [PMID: 27795759 PMCID: PMC5072828 DOI: 10.11604/pamj.2016.24.161.6743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/06/2016] [Indexed: 12/04/2022] Open
Abstract
Paraneoplastic syndromes are a heterogeneous group of clinical and biological manifestations caused by underling neoplasms. They can reveal ovarian teratoma which express neuroendocrine proteins, or contain mature or immature neural tissue inducing an autoimmune response. The etiological investigation is then crucial to early identification of the tumor in order to optimize the prognosis and to limit neurological sequelae. In case of ovarian teratoma, management is essentially based on surgical resection sometimes associated with immunotherapie. We report two new cases of ovarian teratoma revealed by paraneoplastic syndromes in young and menopausal woman.
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Affiliation(s)
- Majdouline Boujoual
- Department of Gynecology-Obstetric, University of Medicine Tangier, Military Training Hospital Med V, Rabat, Maroc
| | - Ihsan Hakimi
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Maroc
| | - Farid Kassidi
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Maroc
| | - Youssef Akhoudad
- Department of Internal Medicine, Military Training Hospital Med V, Rabat, Maroc
| | - Nawal Sahel
- Department of Internal Medicine, Military Training Hospital Med V, Rabat, Maroc
| | - Adil Rkiouak
- Department of Internal Medicine, Military Training Hospital Med V, Rabat, Maroc
| | - Mohamed Allaoui
- Department of Pathology, Military Training Hospital Med V, Rabat, Maroc
| | - Hafsa Chahdi
- Department of Pathology, Military Training Hospital Med V, Rabat, Maroc
| | - Mohamed Oukabli
- Department of Pathology, Military Training Hospital Med V, Rabat, Maroc
| | - Jaouad Kouach
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Maroc
| | | | - Mohamed Dehayni
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Maroc
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Salam S, Lavin T, Turan A. Limbic encephalitis following immunotherapy against metastatic malignant melanoma. BMJ Case Rep 2016; 2016:bcr-2016-215012. [PMID: 27009198 DOI: 10.1136/bcr-2016-215012] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody against programmed cell death antigen (PD-1), is currently being trialled in the UK to treat malignant melanoma. We report a unique case of antibody-negative limbic encephalitis presenting 1 year after starting pembrolizumab, in the context of malignant melanoma. The patient presented with progressive cognitive decline. MRI of the brain revealed signal change within the limbic structures. Cerebrospinal fluid studies confirmed evidence of inflammation with raised white cell count and protein. We were able to prevent further progression of symptoms by stopping pembrolizumab and treating the patient instead with steroids. We advocate considering autoimmune neuroinflammation as a differential for neurological disorders presenting in patients receiving PD-1 antagonist treatment and immunotherapy in general.
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Affiliation(s)
- Sharfaraz Salam
- Greater Manchester Neurosciences Centre, Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Timothy Lavin
- Greater Manchester Neurosciences Centre, Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ayse Turan
- Greater Manchester Neurosciences Centre, Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
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10
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Abstract
We present a case of paraneoplastic limbic encephalitis, describing the presenting features, diagnosis and management plan. Limbic encephalitis is one differential of rapidly progressive dementia. We describe a rational approach to the diagnosis of the patient with rapid cognitive decline.
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Affiliation(s)
- Karim Mahawish
- Department of Elderly Care, Warrington Hospital, Warrington, UK
| | - Lynne Teinert
- Department of Elderly Care, Warrington Hospital, Warrington, UK
| | | | - Joseph Brennan
- Department of Elderly Care, Warrington Hospital, Warrington, UK
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