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Casagrande S, Zuliani L, Grisold W. Paraneoplastic encephalitis. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:131-149. [PMID: 38494274 DOI: 10.1016/b978-0-12-823912-4.00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The first reports of encephalitis associated with cancer date to the 1960s and were characterized by clinical and pathologic involvement of limbic areas. This specific association was called limbic encephalitis (LE). The subsequent discovery of several "onconeural" antibodies (Abs), i.e., Abs targeting an antigen shared by neurons and tumor cells, supported the hypothesis of an autoimmune paraneoplastic etiology of LE and other forms of rapidly progressive encephalopathy. Over the past 20 years, similar clinical pictures with different clinical courses have been described in association with novel Abs-binding neuronal membrane proteins and proved to be pathogenic. The most well-known encephalitis in this group was described in 2007 as an association of a complex neuro-psychiatric syndrome, N-methyl-d-aspartate (NMDA) receptor-Abs, and ovarian teratoma in young women. Later on, nonparaneoplastic cases of NMDA receptor encephalitis were also described. Since then, the historical concept of LE and Ab associated encephalitis has changed. Some of these occur in fact more commonly in the absence of a malignancy (e.g., anti-LG1 Abs). Lastly, seronegative cases were also described. The term paraneoplastic encephalitis nowadays encompasses different syndromes that may be triggered by occult tumors.
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Affiliation(s)
- Silvia Casagrande
- Neurology Unit, Rovereto Hospital, Trento, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Luigi Zuliani
- Department of Neurology, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Jahanshahi A, Salarinejad S, Oraee-Yazdani S, Chehresonboll Y, Morsali S, Jafarizadeh A, Falahatian M, Rahimi F, Jaberinezhad M. Gliomatosis cerebri with blindness: A case report with literature review. Radiol Case Rep 2023; 18:2884-2894. [PMID: 37388536 PMCID: PMC10300258 DOI: 10.1016/j.radcr.2023.05.037] [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: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Cerebral gliomatosis (GC) is a rare diffuse infiltrative growth pattern of glioma with nonspecific clinical manifestations like visual impairment that may involve bilateral temporal lobes. Herpes simplex encephalitis (HSE) and limbic encephalitis (LE) can also lead to temporal lobe involvement. Differentiating these entities is necessary for patients with misleading presentations and imaging findings. To the best of our knowledge, this is the third case of GC presenting with blindness. The patient was a 35 years-old male in a drug rehabilitation center for heroin addiction. He presented with a headache, a single episode of seizure, and a 2-month history of bilateral decrease in visual acuity, which had acutely worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed bilateral temporal lobe involvement. Ophthalmological studies showed bilateral papilledema, absence of visual evoked potential, and thickening of the retinal nerve fiber layer. Due to this clinical presentation, normal laboratory data, and suspicious MRI findings, further investigation with magnetic resonance spectroscopy (MRS) was performed. Results showed a greatly increased ratio of choline to creatinine(Cr) or N-acetyl aspartate (NAA), suggesting a neoplastic nature of the disease. Subsequently, the patient was referred for a brain tissue biopsy with a suspicion of malignancy. The pathology results revealed adult-type diffuse glioma with isocitrate dehydrogenase (IDH) mutation. Bilateral blindness, as well as bilateral temporal lobe involvement, each has many different causes. However, as demonstrated in this study, adult-type diffuse glioma must be considered a rare cause of concomitant bilateral temporal lobe involvement and blindness.
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Affiliation(s)
- Amirreza Jahanshahi
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sareh Salarinejad
- Department of Pathology, Faculty of Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Chehresonboll
- Department of Surgical and Clinical Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Morsali
- Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masih Falahatian
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Rahimi
- Department of Radiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Albsheer K, Fadul A, Abdalla ELM, Mohamed G, Elawad M, Zafar A. Post-COVID-19 Vaccine Limbic Encephalitis: A Case Report. Cureus 2022; 14:e29003. [PMID: 36249609 PMCID: PMC9550179 DOI: 10.7759/cureus.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 12/04/2022] Open
Abstract
Limbic encephalitis (LE) diagnosis can be challenging due to its broad spectrum of clinical presentation and variety of causes. The most commonly known causes include paraneoplastic and autoimmune, but they can also occur post-vaccine. Since 2020, many people worldwide have received the coronavirus disease 2019 (COVID‐19) vaccine after FDA approval. Mild self-limited neurological adverse reactions, including headache and dizziness, were reported post-vaccine. However, emerging few neurological severe events, including encephalitis, have also been reported. Herein, we present a case of a middle-aged female who presented with seizures after two days of receiving the second dose of the Moderna COVID-19 vaccine. A diagnosis of limbic encephalitis was made based on head MRI findings. It was treated with immunosuppressive agents and responded well with no additional neurological sequelae. This case is unique as it highlights a possible association between limbic encephalitis and the COVID-19 vaccine.
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Rare antibody-mediated and seronegative autoimmune encephalitis: An update. Autoimmun Rev 2022; 21:103118. [PMID: 35595048 DOI: 10.1016/j.autrev.2022.103118] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
Paralleling advances with respect to more common antibody-mediated encephalitides, such as anti-N-methyl-D-aspartate receptor (NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) Ab-mediated encephalitis, the discovery and characterisation of novel antibody-mediated encephalitides accelerated over the past decade, adding further depth etiologically to the spectrum of antibody-mediated encephalitis. Herein, we review the major mechanistic, clinical features and management considerations with respect to anti-γ-aminobutyric acid B (GABAB)-, anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropinoic receptor- (AMPAR), anti-GABAA-, anti-dipeptidyl-peptidase-like protein-6 (DPPX) Ab-mediated encephalitides, delineate rarer subtypes and summarise findings to date regarding seronegative autoimmune encephalitis.
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Meier H, Bauer C, Finkenzeller W, Nentwich J, Städt M, Steininger P, Korn K, Essner A, Erbguth F. [Bornavirus encephalitis as a differential diagnosis to seronegative autoimmune encephalitis]. DER NERVENARZT 2022; 93:835-837. [PMID: 35024881 PMCID: PMC8756745 DOI: 10.1007/s00115-021-01259-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- H Meier
- Klinik für Neurologie, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland.
| | - C Bauer
- Klinik für Neurologie, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland.
| | - W Finkenzeller
- Klinik für Neurologie, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - J Nentwich
- Klinik für Innere Medizin, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - M Städt
- Klinik für Neuroradiologie, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - P Steininger
- Virologisches Institut, Universitätsklinikum Erlangen, Schlossgarten 4, 91054, Erlangen, Deutschland
| | - K Korn
- Virologisches Institut, Universitätsklinikum Erlangen, Schlossgarten 4, 91054, Erlangen, Deutschland
| | - A Essner
- Virologisches Institut, Universitätsklinikum Erlangen, Schlossgarten 4, 91054, Erlangen, Deutschland
| | - F Erbguth
- Klinik für Neurologie, Universitätsklinik bzw. Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
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