Multiple myeloma presenting with acute disseminated encephalomyelitis: Causal or chance link?

Language impairments in people with autoimmune neurological diseases: A scoping review

INTRODUCTION

Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used.

METHODS

We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria.

RESULTS

We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used.

CONCLUSIONS

Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.

Monoclonal gammopathy of undetermined significance (MGUS) manifestation in CNS: a regular or chance occurrence?

Monoclonal gammopathy of undetermined significance (MGUS)-associated involvement of the peripheral nervous system is widely reported in the literature. At the same time, involvement of central nervous system (CNS) occurs far less frequently. Analysing the reported cases, almost all the authors pose the question whether there is a relationship between CNS involvement and MGUS, and at what stage it is necessary to begin therapy of haematological disorders. The limited number of reported cases precludes us from getting a definite answer to these questions, thus making further accumulation of clinical data highly relevant. In this article, we present two cases of CNS involvement in patients with MGUS, which, in our opinion, may suggest the existence of a causal relationship between MGUS and CNS involvement. Currently, the above hypothesis cannot be taken as proved due to the lack of a sufficient number of clinical observations and scientific studies. Therefore, the issue of MGUS-associated CNS involvement requires further research.

Hepatic epithelioid hemangioendothelioma associated with acute disseminated encephalomyelitis by a possible paraneoplastic process

Epithelioid hemangioendothelioma (EHE) is a low-grade, malignant vascular neoplasm that frequently involves the liver, lungs, bone, and soft tissue. Although not commonly associated with a paraneoplastic syndrome, paraneoplastic syndromes in the setting of EHE have been reported. Acute disseminated encephalomyelitis (ADEM) is an acute, autoimmune, demyelinating disorder of the central nervous system that most commonly occurs after an infection or vaccination. We present the case of a 23 year old female who developed the acute onset of fevers, tremors, right sided hemiplegia, global aphasia, and incontinence of urine and stool. MRI demonstrated findings consistent with a demyelinating disorder and brain biopsy confirmed the diagnosis of ADEM. The patient's work up revealed multiple liver lesions which were biopsy proven EHE. This case report discusses the diagnosis and treatment of two concurrent rare disease processes and the possible association of the processes via a paraneoplastic syndrome.

Paraneoplastic acute disseminated encephalomyelitis associated with multiple myeloma

We describe a man recently diagnosed with multiple myeloma who presented with progressive spastic paraparesis, encephalopathy and multifocal MRI lesions with haemorrhage. Brain histopathology was consistent with acute disseminated encephalomyelitis (ADEM) with no new clinicoradiological findings on follow-up. This case emphasises the growing paraneoplastic spectrum, including non-classical but treatable disorders such as ADEM.

Small cell lung carcinoma presenting with acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease characterised by subcortical high-signal white matter lesions on T2 weighted MRI. It most commonly occurs in children following an acute viral illness. We present a case study in which ADEM was the presenting condition in an adult female with small cell lung carcinoma. We discuss the evidence in the literature suggesting that ADEM may be viewed as a paraneoplastic syndrome.