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Yoshida T, Kawamura H, Mino K, Konishi Y, Saito T, Shimizu Y, Taketomi A. Gastric cancer complicated by paraneoplastic neurological syndrome which presented with extremity numbness: a case report. Surg Case Rep 2022; 8:78. [PMID: 35482258 PMCID: PMC9051002 DOI: 10.1186/s40792-022-01429-2] [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: 03/06/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Paraneoplastic neurological syndromes refer to a group of neurological disorders, which occur as distant effects of malignant tumors and are not caused by metastasis, nutritional disorders, or side effects of antitumor drugs. Case presentation A 70-year-old woman complained of a 1-month history of extremity numbness. Upon presentation to our hospital, she had worsening numbness, and experienced staggering and falling. Physical examination revealed diminished tendon reflexes in both lower limbs, stocking and glove-type abnormal sensation, and left-sided dominant high-steppage gait due to weakness of the bilateral tibialis anterior muscles. Blood tests indicated anemia, and upper gastrointestinal endoscopy revealed gastric cancer, leading to laparoscopic distal gastrectomy. A nerve conduction velocity test showed demyelinating peripheral neuropathy. Further blood tests and imaging studies ruled out nutritional disorders, such as vitamin deficiency, diabetes-related diseases, connective tissue diseases, and central nervous system metastasis, leading to the suspicion of paraneoplastic neurological syndrome. After laparoscopic distal gastrectomy, the progression of symptoms stopped, and with intravenous high-dose immunoglobulin and steroid therapy, the symptoms improved to only minor numbness in the peripheral limbs as of the 18-month follow-up. As of the 2-year follow-up, there has been no cancer recurrence or metastasis. Conclusions When paraneoplastic neurological syndrome is suspected, early diagnosis and a multidisciplinary approach, including surgical treatment, are important before irreversible neurological damage occurs.
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Affiliation(s)
- Takuto Yoshida
- Department of General Surgery, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan
| | - Hideki Kawamura
- Department of General Surgery, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan.
| | - Kazuhiro Mino
- Department of General Surgery, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan
| | - Yuji Konishi
- Department of General Surgery, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan
| | - Tomoya Saito
- Department of General Surgery, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan
| | - Yuichi Shimizu
- Department of Gastroenterology, Hokkaido Medical Center, 1-1, 5-7 Yamanote, Nishi-ku, Sapporo, 063-0005, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery 1, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Shojima Y, Nishioka K, Watanabe M, Jo T, Tanaka K, Takashima H, Noda K, Okuma Y, Urabe T, Yokoyama K, Hattori N. Clinical Characterization of Definite Autoimmune Limbic Encephalitis: A 30-case Series. Intern Med 2019; 58:3369-3378. [PMID: 31434821 PMCID: PMC6928500 DOI: 10.2169/internalmedicine.3029-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective Limbic encephalitis (LE) is an inflammatory condition of the limbic system that has an acute or subacute onset. Several types of antibodies are related to the onset of LE, including anti-N-methyl D-aspartate receptor (NMDAR) antibodies and voltage-gated potassium channel (VGKC)-complex antibodies. However, the characteristics and prevalence of LE remain unclear, especially in Asian cohorts, due to the rarity. We aimed to survey their characteristics. Materials and Methods Data of 30 cases clinically defined as "definite autoimmune LE" (based on the standard criteria) were retrospectively collected. These patients were categorized into four subtypes: NMDAR (+) (n=8), VGKC (+) (n=2), antibodies related to paraneoplastic syndrome (n=2), and an antibody-negative group (uncategorized) (n=18). Results LE is rare in Japan, and affected only 30 of 16,759 hospital patients (0.2%) over a ten-year period. The NMDAR (+) group showed distinctive symptoms, while the other three groups had similar indications. Brain MRI indicated significant medial temporal lobe atrophy at one year follow up after discharge. The prevalence of cognitive dysfunction as a complication was 64% (9/14). First-line immunotherapy resulted in a good outcome. A drastic improvement was seen from 4.0±1.1 to 1.1+ on the modified Rankin Scale. A good treatment outcome was observed in all groups (NMDAR, VGKC, and uncategorized), suggesting the importance of an early clinical diagnosis and the early initiation of treatment. Furthermore, we reviewed 26 cases that were clinically diagnosed as definitive autoimmune LE in previous case reports. Conclusion Our findings show that the establishment of a clinical diagnosis based on the clinical criteria of definitive autoimmune LE is important for the initiation of immunotherapy.
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Affiliation(s)
- Yuri Shojima
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
| | - Takayuki Jo
- Department of Neurology, Juntendo Shizuoka Hospital, Japan
| | - Keiko Tanaka
- Department of Cellular Neurobiology, Brain Research Institute, Niigata University, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kazuyuki Noda
- Department of Neurology, Juntendo Shizuoka Hospital, Japan
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo Shizuoka Hospital, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
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Jia XT, Pan Y, Di Z, Gu N, Liu Z, Kang YM. Anti-GABA B receptor encephalitis in a patient with gastric adenocarcinoma. Neurol Sci 2018; 39:1981-1984. [PMID: 30109465 DOI: 10.1007/s10072-018-3536-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/11/2018] [Indexed: 11/30/2022]
Abstract
Anti-γ-aminobutyric acid-B (GABAB) receptor encephalitis is an autoimmune encephalitis associated with antibodies against neuronal cell surface antigens, which are primarily observed with small-cell lung cancer, melanoma, and thymoma. Here, we first report a case on the association between a relatively frequent cancer, gastric adenocarcinoma (GAC), and a rare GABAB receptor antibody limbic encephalitis. The patient was treated with immunotherapy and combined-drug chemotherapy, which were partially effective in terms of stabilizing the tumor and relieving neurological symptoms. This report indicates that, when patients present with GABAB receptor antibody limbic encephalitis, regular and broad screening for tumors including gastric adenocarcinoma should also be considered.
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Affiliation(s)
- Xiao-Tao Jia
- Department of Neurology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710003, Shaanxi, People's Republic of China. .,Department of Physiology and Pathophysiology, Cardiovascular Research Center, Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Yanfang Pan
- Department of Pathology, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, People's Republic of China
| | - Zhengli Di
- Department of Neurology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Naibing Gu
- Department of Neurology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Zhiqin Liu
- Department of Neurology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Yu-Ming Kang
- Department of Physiology and Pathophysiology, Cardiovascular Research Center, Xi'an Jiaotong University School of Medicine, Xi'an, 710061, Shaanxi, People's Republic of China.
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Diamanti L, Quaquarini E, Berzero G, Bini P, Gastaldi M, Franciotta D, Alfonsi E, Ceroni M, Frascaroli M, Bernardo A, Marchioni E. Lower motor neuron syndrome in a patient with HER2-positive metastatic breast cancer: A case report and review of the literature. Clin Neurol Neurosurg 2018; 172:141-142. [PMID: 30007590 DOI: 10.1016/j.clineuro.2018.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 01/16/2023]
Abstract
Paraneoplastic neurological syndromes are very rare and often associated to breast, ovarian and small cells lung cancers. Paraneoplastic motor neuron diseases (MNDs) are even rarer, and frequently described in patients with breast cancer. We presented the first case of patient affected by HER2-positive breast tumor and possible paraneoplastic lower motor neuron disease. In literature, few cases are reported but no one highlights the tumor receptors' profile. Instead, HER2-positive breast cancers are prone to be related to anti-Yo-associated paraneoplastic cerebellar disorders. Anti-onconeural antibodies positivity can be rarely found, confirming that paraneoplastic MND have no specific biomarkers. The presence of CSF oligoclonal bands (OBs) suggests the presence of immune-mediated mechanism, in absence of other possible OBs causes.
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Affiliation(s)
- Luca Diamanti
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Erica Quaquarini
- Department of Oncology, ICS Maugeri IRCCS, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
| | - Giulia Berzero
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paola Bini
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy
| | - Matteo Gastaldi
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Diego Franciotta
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy
| | - Enrico Alfonsi
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy
| | - Mauro Ceroni
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Enrico Marchioni
- IRCCS "C. Mondino" Foundation, National Neurological Institute, Pavia, Italy
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