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Hickman SJ. Paraneoplastic Syndromes in Neuro-Ophthalmology. Ann Indian Acad Neurol 2022; 25:S101-S105. [PMID: 36589030 PMCID: PMC9795712 DOI: 10.4103/aian.aian_102_22] [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: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/04/2023] Open
Abstract
Paraneoplastic neurological syndromes (PNS) occur in about 1 in 300 cases of cancer. The usual mechanism is that an antigen on the cancer sets off an immune response that then cross-reacts with a nervous system antigen. The presentation is usually with a subacute progressive neurological disorder. The management of these conditions is usually of both the underlying tumor and immunomodulation to suppress the autoimmune response. There are a number of these conditions that can present to the Neuro-Ophthalmology clinic, either as a discrete condition affecting vision or eye movements or as part of a more widespread neurological disorder. This article will discuss these conditions, their management and prognosis.
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Affiliation(s)
- Simon J. Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
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Valiyaveettil D, Jilla S, Krishna JM, Kollu R, Patil C, Gupta R. Cisplatin induced cerebral sinus venous thrombosis in cervical cancer patients treated with concurrent chemoradiation: a case series. Ecancermedicalscience 2022; 15:1320. [PMID: 35047071 PMCID: PMC8723748 DOI: 10.3332/ecancer.2021.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
Cisplatin is a widely used chemotherapeutic agent. Concurrent chemotherapy with cisplatin is an important component in the management of carcinoma cervix. The common side effects of cisplatin chemotherapy include nausea, vomiting, dyselectrolytemia, nephrotoxicity, etc. These side effects are anticipated and managed during chemotherapy. Thromboembolic events are rare complications with cisplatin. We present three cases of cisplatin related cerebral sinus venous thrombosis (CSVT). These patients were receiving concurrent chemoradiation for carcinoma cervix. These patients presented with neurological symptoms and were evaluated and diagnosed with CSVT. They recovered after appropriate management. Clinicians should be aware that CSVT, though uncommon, is a life threatening complication during cisplatin chemotherapy which should be appropriately evaluated and effectively managed.
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Affiliation(s)
- Deepthi Valiyaveettil
- Department of Radiation Oncology, Malla Reddy Cancer Hospital and Research Institute, Hyderabad 500055, India
| | - Swapna Jilla
- Department of Radiation Oncology, Malla Reddy Cancer Hospital and Research Institute, Hyderabad 500055, India
| | | | - Raja Kollu
- Department of Radiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad 500055, India
| | - Chandrasekhar Patil
- Department of Radiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad 500055, India
| | - Ranadheer Gupta
- Department of Nuclear Medicine, Malla Reddy Cancer Hospital and Research Institute, Hyderabad 500055, India
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Bozpolat A, Unal E, Topaloglu T, Taheri S, Bayram AK, Ozcan A, Karakukcu M, Ozdemir MA, Per H. The relationship between the prognosis of children with acute arterial stroke and polymorphisms of CDKN2B, HDAC9, NINJ2, NAA25 genes. J Thromb Thrombolysis 2019; 47:578-584. [DOI: 10.1007/s11239-018-01802-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cerebral Sinus Venous Thrombosis and Prothrombotic Risk Factors in Children: A Single-Center Experience From Turkey. J Pediatr Hematol Oncol 2018; 40:e369-e372. [PMID: 29668537 DOI: 10.1097/mph.0000000000001149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is a rare cerebrovascular disease that may be life-threatening, especially in children. OBJECTIVE The purpose of this study was to assess the clinical presentation, radiologic imaging, underlying conditions, treatment, and outcomes of children with CSVT. PATIENTS AND METHODS In total, 23 consecutive children aged between 1 month to 18 years with CSVT, who were followed-up in Erciyes University Children's Hospital, were retrospectively enrolled in the study from January 2000 to December 2016. RESULTS The median age of the 23 children (13 female patients, 10 male patients) at initial diagnosis was 60 months (1 to 204 mo). The most common clinical manifestation was headache/irritability (n=9). The most common site of the CSVT was the transverse sinus (n=16). The most common prothrombotic risk factor was protein C deficiency (n=4). Underlying risk factors were detected in 15 patients. Genetic risk factors such as protein C deficiency, infections, trauma, malignancies, autoimmune hemolytic anemia, neurometabolic disorders, asphyxia, and cardiac malformations were common risk factors. Six children died. Multiple sinus involvement and parenchymal hemorrhages were seen in 4 and in 3 of the 6 children who died, respectively. CONCLUSIONS Protein C deficiency seemed to be relatively high in the presented children. Multiple sinus involvement and additional parenchymal hemorrhages represent poor prognostic features.
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An Unusual Cause of Subacute Headache in a Patient Undergoing Chemotherapy for Advanced Testicular Nonseminomatous Germ Cell Tumour. Case Rep Oncol Med 2016; 2016:4317108. [PMID: 27200199 PMCID: PMC4856940 DOI: 10.1155/2016/4317108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/02/2016] [Accepted: 04/12/2016] [Indexed: 11/21/2022] Open
Abstract
Testicular (germ cell) cancer is a model of a chemocurable malignancy and tends to have a favourable prognosis even in advanced stages due to exquisite sensitivity to platinum-based chemotherapy. However, both acute and longer-term toxicities of multiagent chemotherapy remain significant as causes of morbidity, very occasionally mortality, and impaired quality-of-life. Here, we report a case of acute cerebral venous sinus thrombosis occurring within 10 days of chemotherapy initiation in a young patient without comorbidities, whose only predisposing factors were malignancy, chemotherapy, and perhaps mild dehydration. The clinical presentation was also unusual with headache of moderate severity only without focal or global neurologic deficits. We suspect that cisplatin may have had direct vasculotoxic effects. The patient recovered fully after short-duration anticoagulation but oncologists must remain aware of unusual and unpredictable complications of cytotoxic treatment.
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Tuncel T, Ozgun A, Emirzeoğlu L, Celik S, Demir S, Bilgi O, Karagoz B. Broca's aphasia due to cerebral venous sinus thrombosis following chemotherapy for small cell lung cancer: A case report and review of literature. Oncol Lett 2014; 9:937-939. [PMID: 25621071 PMCID: PMC4301499 DOI: 10.3892/ol.2014.2709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 09/26/2014] [Indexed: 11/21/2022] Open
Abstract
Cancer is associated with an increased risk of cerebrovascular incidents and treatment with chemotherapy enhances that risk further. Brocha’s aphasia is a stroke-related syndrome, the presentation of which has been rarely reported during cisplatin-based chemotherapy. The current study presents the case of a 27-year-old male with advanced-stage small cell lung cancer. The patient developed Broca’s aphasia following cisplatin-based chemotherapy.
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Affiliation(s)
- Tolga Tuncel
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Alpaslan Ozgun
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Levent Emirzeoğlu
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Serkan Celik
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Serkan Demir
- Department of Neurology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Oguz Bilgi
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
| | - Bulent Karagoz
- Department of Medical Oncology, Gata Haydarpasa Training Hospital, Istanbul 34668, Turkey
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Cranial metastatic alveolar rhabdomyosarcoma mimicking hematological malignancy in an adolescent boy. Childs Nerv Syst 2014; 30:1737-41. [PMID: 24917491 DOI: 10.1007/s00381-014-2443-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Widespread alveolar rhabdomyosarcoma (ARMS) with bone marrow involvement and with an unknown primary tumor, especially presenting with acute tumor lysis syndrome can be easily misdiagnosed as a hematological malignancy. Furthermore, brain metastasis of ARMS is rare seen in children. CASE REPORT Herein, we report a 14-year-old boy presenting with acute tumor lysis syndrome due to bone marrow invasion of ARMS, who was diagnosed after abdominal paraaortic lymph node biopsy. Despite radiological and nuclear medicine imaging, the primary tumor site could not be found. He was treated with vincristine, topotecan, and cyclophosphamide for 42 weeks. Six months after the completion of treatment, he suffered from severe headache, blurred vision, right hemiplegia, and severe bone pain. Cranial magnetic resonance imaging showed multiple hemorrhagic infarctions. Brain biopsy showed brain metastasis with PAX3-FKHR fusion transcript. CONCLUSION The clinicians must be vigilant about solely brain metastasis in ARMS without additional metastasis.
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Per H, Unal E, Poyrazoglu HG, Ozdemir MA, Donmez H, Gumus H, Uzum K, Canpolat M, Akyildiz BN, Coskun A, Kurtsoy A, Kumandas S. Childhood stroke: results of 130 children from a reference center in Central Anatolia, Turkey. Pediatr Neurol 2014; 50:595-600. [PMID: 24842257 DOI: 10.1016/j.pediatrneurol.2013.12.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke. METHODS The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed. RESULTS Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis. CONCLUSION Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.
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Affiliation(s)
- Huseyin Per
- Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ekrem Unal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Hatice Gamze Poyrazoglu
- Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Akif Ozdemir
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Halil Donmez
- Division of Interventional Radiology, Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Hakan Gumus
- Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Kazım Uzum
- Division of Pediatric Cardiology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Canpolat
- Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Basak Nur Akyildiz
- Pediatric Intensive Care Unit, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Abdulhakim Coskun
- Division of Pediatric Radiology, Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ali Kurtsoy
- Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Sefer Kumandas
- Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
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Kose D, Paksoy Y, Koksal Y, Unal E. Neurological complication of non Hodgkin lymphoma in childhood: experience from a single center in Turkey. Childs Nerv Syst 2014; 30:639-45. [PMID: 23989474 DOI: 10.1007/s00381-013-2267-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Lymphomas are the third most common childhood malignant disease after leukemia and central nervous system (CNS) tumors. Early diagnosis of these complications will reduce mortality and morbidity. In this study we aimed to review the neurological complications of childhood non Hodgkin Lymphoma (NHL). PATIENTS AND METHODS Forty four children with NHL between 2006 and 2012 were investigated retrospectively and 14 cases with neurological complications were identified. RESULTS The most common symptom was alteration of the consciousness (10 patients, 71.4 %) followed by convulsion (5 patients, 35.7 %), and hallucination (4 patients, 28.5 %); headache, eye pain, neurogenic bladder, speech disability and facial paralysis, and hemiplegia, were less common and each of them was seen in 1 (7.1 %) of the patients. The neurological complications were mostly seen in children with precursor T lymphoblastic lymphoma followed by anaplastic large cell lymphoma. The complications were secondary to medications (Eight patients) infection (two patients); CNS relapse (two patients); or CNS involvement of the primary disease (two patients). Chemotherapy-related neurologic complications were secondary to intrathecal methotrexate, L-asparaginase, vincristine, and ifosfamide CONCLUSION Advanced disease and PTLL subtype can be suggested as predictors of neurological complication. The survival rates of neurological complications are fairly good unless it is secondary to involvement of the primary disease. In patients with drug-induced neurological complications, the treatment can be safely re-administered after controlling the neurological complications. Therefore, clinicians managing children with NHL must be informative about neurological complications.
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Affiliation(s)
- Dogan Kose
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Selçuk University, Konya, Turkey,
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Cerebral venous thrombosis: a mimic of brain metastases in colorectal cancer associated with a better prognosis. Case Rep Oncol Med 2013; 2013:109412. [PMID: 23840992 PMCID: PMC3697227 DOI: 10.1155/2013/109412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/30/2013] [Indexed: 11/17/2022] Open
Abstract
Malignancy is known to be one of the predisposing factors of cerebral venous thrombosis (CVT) due to its hypercoagulable state. CVT is a rare disorder which can lead to frequent misdiagnoses of brain metastases in such cases. We report here the case of a 35-year-old female with metastatic colon adenocarcinoma presenting with sudden neurological symptoms. Brain MRI and magnetic resonance venography confirmed the presence of CVT. She was treated with low molecular weight heparin followed by warfarin. She recovered and is doing well on warfarin after 5 months of diagnosis of CVT. CVT should be strongly suspected as a cause of neurological dysfunction in any case of disseminated malignancy including colon adenocarcinoma. Rapid diagnosis and initiation of therapy should be considered because of its favourable outcome.
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Kondolot M, Unal E, Poyrazoglu G, Kara A, Yikilmaz A, Kumandas S, Arslan D. Orbital myositis associated with focal active colitis in a teenage girl. Childs Nerv Syst 2012; 28:641-3. [PMID: 22009155 DOI: 10.1007/s00381-011-1613-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
Affiliation(s)
- Meda Kondolot
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Papet C, Gutzeit A, Pless M. Two cases of cerebral sinus venous thrombosis following chemotherapy for non-seminomatous germ cell tumor. Case Rep Oncol 2011; 4:555-9. [PMID: 22220149 PMCID: PMC3251244 DOI: 10.1159/000334850] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report on two patients with cerebral sinus venous thrombosis following chemotherapy with cisplatin, bleomycin and etoposide for non-seminomatous germ cell tumor. Headache and neurological deficits were the leading symptoms. Cancer and cisplatin chemotherapy are well-known risk factors for thromboembolic events. The therapeutic strategy is an anticoagulant therapy. Symptoms are usually reversible within weeks under this therapy. Therefore, in patients with testicular cancer and chemotherapy who present with neurological symptoms, cerebral sinus venous thrombosis should be considered in the differential diagnosis.
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Affiliation(s)
- C Papet
- Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke 2009; 4:111-23. [PMID: 19383052 DOI: 10.1111/j.1747-4949.2009.00260.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cerebral venous sinus thrombosis is an uncommon disease marked by clotting of blood in cerebral venous, or dural sinuses, and, in rare cases, cortical veins. It is a rare but potentially fatal cause of acute neurological deterioration previously related to otomastoid, orbit, and central face cutaneous infections. After the advent of antibiotics, it is more often related to neoplasm, pregnancy, puerperium, systemic diseases, dehydration, intracranial tumors, oral contraceptives, and coagulopathies are the most common causes, but in 30% of cases no underlying etiology can be identified. It has been found in association with fibrous thyroiditis, jugular thrombosis after catheterization, or idiopathic jugular vein stenosis. Other factors include surgery, head trauma, arterio-venous malformations, infection, paraneoplastic, and autoimmune disease. This article presents a comprehensive review of cerebral venous sinus thrombosis etiologies.
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Affiliation(s)
- Mohammad Saadatnia
- Neurology Department, Isfahan University of Medical Sciences, Isfahan, Iran
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