Paraneoplastic cerebellar degeneration(PCD),which is rare in clinical practice,is closely related to autoimmunity.Cases positive for anti-Yo antibodies(anti-Purkinje cytoplasmic antibody 1)are the main subtype of PCD....Paraneoplastic cerebellar degeneration(PCD),which is rare in clinical practice,is closely related to autoimmunity.Cases positive for anti-Yo antibodies(anti-Purkinje cytoplasmic antibody 1)are the main subtype of PCD.PCD is subacute cerebellar degeneration,and while it progresses over weeks to months,its resultant deficits last much longer.Cancer patients with anti-Yo antibody-positive PCD are very rare.Most of them are breast cancer or ovarian cancer patients but also occasionally lung cancer patients.CASE SUMMARY A 61-year-old woman presented with sudden vertigo,nausea,and vomiting for approximately 10 d.The patient's neurological examination showed torsion with downbeat nystagmus and ataxia of the right limb and trunk.Laboratory examination found that the patient's cerebrospinal fluid and serum were anti-Yo antibody-positive,positron emission tomography computed tomography showed an increased metabolic rate in the retroperitoneal lymph nodes,and the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct,which strengthens the hypothesis of paraneoplastic origin.Intravenous immunoglobulin(IVIg)0.4 g/kg/d for 5 d and methylprednisolone 160 mg for 3 d were initiated,which was reduced to 80 mg for 3 d and then to 40 mg for 7 d.After treatment with IVIg and a steroid,the patient's vertigo and ataxia alleviated.CONCLUSION The patient's vertigo and ataxia alleviated after treatment,suggesting that early immunotherapeutic intervention may have certain value in stopping neurological loss.展开更多
BACKGROUND Paraneoplastic neurological syndrome(PNS)is a rare complication in patients with cancer.PNS can affect the central,peripheral,autonomic nervous system,neuromuscular junction,or muscles and cause various neu...BACKGROUND Paraneoplastic neurological syndrome(PNS)is a rare complication in patients with cancer.PNS can affect the central,peripheral,autonomic nervous system,neuromuscular junction,or muscles and cause various neurological symptoms.Anti-Yo antibody-positive neurological paraneoplasms and anti-Hu antibodypositive neurological paraneoplasms are common,but coexistence of both types has not been described in the literature.CASE SUMMARY Here we present a rare case of paraneoplastic neuropathy occurring in both breast and lung cancers.A 55-year-old woman was admitted to our hospital with unsteadiness while walking.The patient had a history of breast cancer two years previously.Chest computed tomography revealed a 4.6 cm×3.6 cm mass in the right lung,which was diagnosed as small-cell lung cancer(SCLC).Blood test was positive for anti-Yo antibodies,and the cerebrospinal fluid was positive for both anti-Yo and anti-Hu antibodies,and the neurological symptoms were considered to be related to the paraneoplasm.The patient was treated with a course of intravenous immunoglobulin,without noticeable improvement.After being discharged from hospital,the patient underwent regular chemotherapy for SCLC and periodic reviews.The patient’s neurological symptoms continued to deteriorate at the follow-up visit in April 2021.CONCLUSION This case suggests the possibility of two types of tumors appearing simultaneously with two paraneoplastic antibodies.The clinical appearance of two or more paraneoplastic tumors requires additional attention.展开更多
Paraneoplastic neurologic syndromes （PNSs） occur with increased frequency in patients with cancer and almost always antedate its diagnosis.These syndromes comprise a heterogeneous group of cancer-related neurologic ...Paraneoplastic neurologic syndromes （PNSs） occur with increased frequency in patients with cancer and almost always antedate its diagnosis.These syndromes comprise a heterogeneous group of cancer-related neurologic diseases,and they may affect any part of the nervous system.The simultaneous involvement of different areas of the nervous system by the paraneoplastic process is not unusual.Until date,this is the first report of concurrent development of paraneoplastic cerebellar degeneration （PCD） and paraneoplastic limbic encephalitis （PLE） associated with the advanced ovarian cancer and anti-Yo antibodies following hepatitis B （HB） vaccination.The cause of most PNS is believed to be an immune response against neuronal proteins expressed by the tumor.展开更多
基金Natural Science Foundation of Zhejiang Province,No.LQ19H090006Department of Health of Zhejiang Province,No.2019KY260.
文摘Paraneoplastic cerebellar degeneration(PCD),which is rare in clinical practice,is closely related to autoimmunity.Cases positive for anti-Yo antibodies(anti-Purkinje cytoplasmic antibody 1)are the main subtype of PCD.PCD is subacute cerebellar degeneration,and while it progresses over weeks to months,its resultant deficits last much longer.Cancer patients with anti-Yo antibody-positive PCD are very rare.Most of them are breast cancer or ovarian cancer patients but also occasionally lung cancer patients.CASE SUMMARY A 61-year-old woman presented with sudden vertigo,nausea,and vomiting for approximately 10 d.The patient's neurological examination showed torsion with downbeat nystagmus and ataxia of the right limb and trunk.Laboratory examination found that the patient's cerebrospinal fluid and serum were anti-Yo antibody-positive,positron emission tomography computed tomography showed an increased metabolic rate in the retroperitoneal lymph nodes,and the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct,which strengthens the hypothesis of paraneoplastic origin.Intravenous immunoglobulin(IVIg)0.4 g/kg/d for 5 d and methylprednisolone 160 mg for 3 d were initiated,which was reduced to 80 mg for 3 d and then to 40 mg for 7 d.After treatment with IVIg and a steroid,the patient's vertigo and ataxia alleviated.CONCLUSION The patient's vertigo and ataxia alleviated after treatment,suggesting that early immunotherapeutic intervention may have certain value in stopping neurological loss.
基金Supported by Natural Science Foundation of Gansu Province,No.20JR10RA719。
文摘BACKGROUND Paraneoplastic neurological syndrome(PNS)is a rare complication in patients with cancer.PNS can affect the central,peripheral,autonomic nervous system,neuromuscular junction,or muscles and cause various neurological symptoms.Anti-Yo antibody-positive neurological paraneoplasms and anti-Hu antibodypositive neurological paraneoplasms are common,but coexistence of both types has not been described in the literature.CASE SUMMARY Here we present a rare case of paraneoplastic neuropathy occurring in both breast and lung cancers.A 55-year-old woman was admitted to our hospital with unsteadiness while walking.The patient had a history of breast cancer two years previously.Chest computed tomography revealed a 4.6 cm×3.6 cm mass in the right lung,which was diagnosed as small-cell lung cancer(SCLC).Blood test was positive for anti-Yo antibodies,and the cerebrospinal fluid was positive for both anti-Yo and anti-Hu antibodies,and the neurological symptoms were considered to be related to the paraneoplasm.The patient was treated with a course of intravenous immunoglobulin,without noticeable improvement.After being discharged from hospital,the patient underwent regular chemotherapy for SCLC and periodic reviews.The patient’s neurological symptoms continued to deteriorate at the follow-up visit in April 2021.CONCLUSION This case suggests the possibility of two types of tumors appearing simultaneously with two paraneoplastic antibodies.The clinical appearance of two or more paraneoplastic tumors requires additional attention.
文摘Paraneoplastic neurologic syndromes （PNSs） occur with increased frequency in patients with cancer and almost always antedate its diagnosis.These syndromes comprise a heterogeneous group of cancer-related neurologic diseases,and they may affect any part of the nervous system.The simultaneous involvement of different areas of the nervous system by the paraneoplastic process is not unusual.Until date,this is the first report of concurrent development of paraneoplastic cerebellar degeneration （PCD） and paraneoplastic limbic encephalitis （PLE） associated with the advanced ovarian cancer and anti-Yo antibodies following hepatitis B （HB） vaccination.The cause of most PNS is believed to be an immune response against neuronal proteins expressed by the tumor.
