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Calandrelli R, Marco P, Tran HE, Colosimo C, Pilato F. A Novel Radiological Score System to Assess the Clinical Severity in Patients with Acute Cerebellitis. CEREBELLUM (LONDON, ENGLAND) 2023; 22:173-182. [PMID: 35137363 DOI: 10.1007/s12311-022-01377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
To develop a radiological score system to assess the severity of acute cerebellitis (AC) and to compare radiological severity score at the onset to cerebellar atrophy at follow-up. Clinical and MRI findings were recorded in 16 patients with AC. Radiological severity score considering topographic patterns, gray/white matter involvement, enhancement, tonsillar herniation or hydrocephalus development and clinical severity score taking into account clinical symptoms were assessed for each patient at the onset of the symptoms. Radiological and neurological sequelae were assessed at follow-up. At symptoms onset, clinical severity scale ranged from mild to severe and radiological severity score ranged from 3 to 7 with higher scores indicating a greater severity. The cut-off value of 5 for radiological score well segregated severe patients defined by clinical scale. A significant correlation between clinical scale and radiological severity scores (p < 0.001, r = 0.75) was found. At follow-up visit, all children developed cerebellar atrophy and 5 children showed neurologic sequelae while adults showed complete resolution without atrophy. Patients in whom atrophy was not observed had both older ages (p < 0.001) and a focal cerebellar involvement (p = 0.03). In patients with AC, radiological severity score may be a useful tool in evaluating clinical severity, but it is not capable to predict neither neurological sequelae nor evolution towards atrophy. Cerebellar atrophy, observed in children with AC, may be caused by several factors such as the age of patient and the extension of cerebellar involvement and it may be counterbalanced by neuronal restoring processes due to neuroplasticity.
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Affiliation(s)
- Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica per Immagini, Rome, Italy
| | - Panfili Marco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica per Immagini, Rome, Italy
| | - Huong Elena Tran
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica per Immagini, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128, Rome, Italy.
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Sakoda M, Sarhadi K, Weisner PA, Tierney S, Wang Y. Clinical Reasoning: A 67-Year-Old Woman With Progressive Diplopia, Vertigo, and Ataxia. Neurology 2021; 98:e669-e674. [PMID: 34862319 DOI: 10.1212/wnl.0000000000013141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Update on Paraneoplastic Cerebellar Degeneration. Brain Sci 2021; 11:brainsci11111414. [PMID: 34827413 PMCID: PMC8615604 DOI: 10.3390/brainsci11111414] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose of review: To provide an update on paraneoplastic cerebellar degeneration (PCD), the involved antibodies and tumors, as well as management strategies. Recent findings: PCD represents the second most common presentation of the recently established class of immune mediated cerebellar ataxias (IMCAs). Although rare in general, PCD is one of the most frequent paraneoplastic presentations and characterized clinically by a rapidly progressive cerebellar syndrome. In recent years, several antibodies have been described in association with the clinical syndrome related to PCD; their clinical significance, however, has yet to be determined. The 2021 updated diagnostic criteria for paraneoplastic neurologic symptoms help to establish the diagnosis of PCD, direct cancer screening, and to evaluate the presence of these newly identified antibodies. Recognition of the clinical syndrome and prompt identification of a specific antibody are essential for early detection of an underlying malignancy and initiation of an appropriate treatment, which represents the best opportunity to modulate the course of the disease. As clinical symptoms can precede tumor diagnosis by years, co-occurrence of specific symptoms and antibodies should prompt continuous surveillance of the patient. Summary: We provide an in-depth overview on PCD, summarize recent findings related to PCD, and highlight the transformed diagnostic approach.
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Enríquez-Marulanda A, Beltrán-Osorio LD, Escobar LA, Granados AM, Velásquez-Lasprilla F, Orozco JL. Anti-Yo-Associated Paraneoplastic Cerebellar Degeneration Manifesting as Acute Cerebellitis with Posterior Cranial Fossa Hypertension. World Neurosurg 2018; 112:117-122. [PMID: 29378343 DOI: 10.1016/j.wneu.2018.01.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Paraneoplastic cerebellar degeneration (PCD) is a rare complication of some malignant cancers. It is most commonly described in women with gynecologic or breast malignancies; however, there have been reports in other types of cancers. Symptoms include ataxia, dysarthria, and tremors, which could be the first manifestations of an underlying malignancy. CASE DESCRIPTION A 50-year-old woman had an acute PCD with anti-Yo antibodies from an underlying breast invasive ductal carcinoma. She presented with intracranial hypertension in the posterior cranial fossa that required an emergent decompressive craniectomy. CONCLUSIONS PCD is an uncommon disease that may manifest initially as posterior cranial fossa hypertension and subsequent acute hydrocephalus owing to diffuse cerebellar swelling. To our knowledge, this is the first described case of an anti-Yo PCD that has manifested as acute posterior cranial fossa hypertension owing to diffuse cerebellar edema. Early diagnosis and treatment should be pursued to improve long-term outcomes.
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Affiliation(s)
- Alejandro Enríquez-Marulanda
- Universidad Icesi, Faculty of Medicine, Cali, Colombia; Clinical Research Centre, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Luis David Beltrán-Osorio
- Clinical Research Centre, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Luis Alberto Escobar
- Universidad Icesi, Faculty of Medicine, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Ana María Granados
- Universidad Icesi, Faculty of Medicine, Cali, Colombia; Clinical Research Centre, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Fernando Velásquez-Lasprilla
- Universidad Icesi, Faculty of Medicine, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Jorge Luis Orozco
- Universidad Icesi, Faculty of Medicine, Cali, Colombia; Clinical Research Centre, Cali, Colombia; Department of Neuroscience, Fundación Valle del Lili Hospital, Cali, Colombia.
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Abstract
Immune-mediated cerebellar ataxia (CA) comprises a group of rare diseases that are still incompletely described, and are probably underdiagnosed. Both acute and progressive progressions are possible. Different syndromes have been identified, including CA associated with anti-GAD antibodies, the cerebellar type of Hashimoto encephalopathy, primary autoimmune CA, gluten ataxia, opsoclonus-myoclonus syndrome, and paraneoplastic cerebellar degenerations. Most of these syndromes are associated with autoantibodies targeting neuronal antigens. Additionally, autoimmune CA can be triggered by infections, especially in children, and in rare cases occur in the context of an autoimmune multisystem disease, such as systemic lupus erythematosus, sarcoidosis, or Behçet disease. A careful workup is needed to distinguish autoimmune CA from other causes. In adults, a paraneoplastic origin must be ruled out, especially in cases with subacute onset. Neurologic outcome in adults is frequently poor, and optimal therapeutic strategies remain ill defined. The outcome in children is in general good, but children with a poor recovery are on record. The precise pathophysiologic mechanisms even in the presence of detectable autoantibodies are still largely unknown. Further research is needed on both the clinical and mechanistic aspects of immune-mediated CA, and to determine optimal therapeutic strategies.
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Affiliation(s)
- Bastien Joubert
- French Reference Centre for Paraneoplastic Neurological Syndromes, Lyon Neurological Hospital, Lyon, France; Institut NeuroMyoGene, Université Claude Bernard Lyon 1, Lyon, France
| | - Kevin Rostásy
- Department of Pediatric Neurology, Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany
| | - Jérôme Honnorat
- French Reference Centre for Paraneoplastic Neurological Syndromes, Lyon Neurological Hospital, Lyon, France; Institut NeuroMyoGene, Université Claude Bernard Lyon 1, Lyon, France.
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Helton K, Patterson AL, Khan RB, Sadighi ZS. The Complex Diagnostic Challenge in Children With Non-Central Nervous System Cancer and Cerebellar Mutism. J Child Neurol 2017; 32:823-827. [PMID: 28497710 DOI: 10.1177/0883073817709178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multiple etiologies should be considered in the differential diagnosis of immunocompromised patients with non-central nervous system cancer and viral infections who develop mutism. Acute cerebellitis, caused by infections or by neurotoxicity resulting from chemotherapy; paraneoplastic cerebellar degeneration; atypical posterior reversible encephalopathy syndrome; and acute disseminated encephalomyelitis may all cause mutism in such patients. This condition warrants prompt recognition and may require treatment with immunotherapy, as it may be an immune-mediated process. We present 2 patients with leukemia and viral illness who developed cerebellar mutism in the setting of acute cerebellitis and responded to immunotherapy, suggesting that the condition involved a parainfectious immune-mediated response.
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Affiliation(s)
- Kathleen Helton
- 1 Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amy L Patterson
- 2 Department of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Raja B Khan
- 3 Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zsila S Sadighi
- 3 Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Gupta R, Maralani PJ, Chawla S, Gopal PP, Mohan S. Advanced neuroimaging findings of pseudotumoral hemicerebellitis in an elderly male requiring surgical decompression. J Neurosurg 2014; 120:522-7. [DOI: 10.3171/2013.11.jns13980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute cerebellitis is an inflammatory process that usually affects bilateral cerebellar hemispheres in the pediatric population. Pseudotumoral hemicerebellitis is an extremely rare presentation in which unilateral cerebellar involvement mimics a tumor that can exert significant mass effect on the surrounding structures, which may require surgical intervention. Magnetic resonance imaging characteristics that suggest cerebellitis include cerebellar swelling, T2 hyperintensity, and pial enhancement. Advanced neuroimaging, including MR perfusion and MR spectroscopy, may be helpful in excluding other diagnoses. The authors present the case of pseudotumoral hemicerebellitis in the oldest documented patient, a 73-year-old man who required surgical decompression, and they provide a brief discussion of advanced neuroimaging findings.
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Affiliation(s)
- Rajesh Gupta
- 1Department of Medicine, Akron General Medical Center, Akron, Ohio; and
| | | | | | - Pallavi P. Gopal
- 3Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Manto M, Jissendi P. Infectious Diseases of the Posterior Fossa. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2013:2027-2038. [DOI: 10.1007/978-94-007-1333-8_93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
PURPOSE OF REVIEW The most relevant advances in immune-mediated movement disorders are described, with emphasis on the clinical--immunological associations, novel antigens, and treatment. RECENT FINDINGS Many movement disorders previously considered idiopathic or degenerative are now recognized as immune-mediated. Some disorders are paraneoplastic, such as anti-CRMP5-associated chorea, anti-Ma2 hypokinesis and rigidity, anti-Yo cerebellar ataxia and tremor, and anti-Hu ataxia and pesudoathetosis. Other disorders such as Sydenham's chorea, or chorea related to systemic lupus erythematosus and antiphospholipid syndrome occur in association with multiple antibodies, are not paraneoplastic, and are triggered by molecular mimicry or unknown mechanisms. Recent studies have revealed a new category of disorders that can be paraneoplastic or not, and associate with antibodies against cell-surface or synaptic proteins. They include anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, which may cause dyskinesias, chorea, ballismus or dystonia (NMDAR antibodies), the spectrum of Stiff-person syndrome/muscle rigidity (glutamic acid decarboxylase, amphiphysin, GABA(A)-receptor-associated protein, or glycine receptor antibodies), neuromyotonia (Caspr2 antibodies), and opsoclonus--myoclonus--ataxia (unknown antigens). SUMMARY Neurologists should be aware that many movement disorders are immune-mediated. Recognition of these disorders is important because it may lead to the diagnosis of an occult cancer, and a substantial number of patients, mainly those with antibodies to cell-surface or synaptic proteins, respond to immunotherapy.
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Affiliation(s)
- Jessica Panzer
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Manto M, Jissendi P. Brain Imaging in Cerebellar Ataxia Associated with Autoimmune Polyglandular Syndrome Type 2. J Neuroimaging 2010; 22:308-11. [DOI: 10.1111/j.1552-6569.2010.00542.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Marmolino D, Manto M. Past, present and future therapeutics for cerebellar ataxias. Curr Neuropharmacol 2010; 8:41-61. [PMID: 20808545 PMCID: PMC2866461 DOI: 10.2174/157015910790909476] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/18/2009] [Accepted: 11/30/2009] [Indexed: 01/14/2023] Open
Abstract
Cerebellar ataxias are a group of disabling neurological disorders. Patients exhibit a cerebellar syndrome and can also present with extra-cerebellar deficits, namely pigmentary retinopathy, extrapyramidal movement disorders, pyramidal signs, cortical symptoms (seizures, cognitive impairment/behavioural symptoms), and peripheral neuropathy. Recently, deficits in cognitive operations have been unraveled. Cerebellar ataxias are heterogeneous both at the phenotypic and genotypic point of view. Therapeutical trials performed during these last 4 decades have failed in most cases, in particular because drugs were not targeting a deleterious pathway, but were given to counteract putative defects in neurotransmission. The identification of the causative mutations of many hereditary ataxias, the development of relevant animal models and the recent identifications of the molecular mechanisms underlying ataxias are impacting on the development of new drugs. We provide an overview of the pharmacological treatments currently used in the clinical practice and we discuss the drugs under development.
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Affiliation(s)
- D Marmolino
- Laboratoire de Neurologie Expèrimentale ULB-Erasme, Brussels, Belgium.
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