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O'Brien JA, Karrasch JF, Huang Y, Vine EE, Cunningham AL, Harman AN, Austin PJ. Nerve-myeloid cell interactions in persistent human pain: a reappraisal using updated cell subset classifications. Pain 2024; 165:753-771. [PMID: 37975868 DOI: 10.1097/j.pain.0000000000003106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/04/2023] [Indexed: 11/19/2023]
Abstract
ABSTRACT The past 20 years have seen a dramatic shift in our understanding of the role of the immune system in initiating and maintaining pain. Myeloid cells, including macrophages, dendritic cells, Langerhans cells, and mast cells, are increasingly implicated in bidirectional interactions with nerve fibres in rodent pain models. However, our understanding of the human setting is still poor. High-dimensional functional analyses have substantially changed myeloid cell classifications, with recently described subsets such as epidermal dendritic cells and DC3s unveiling new insight into how myeloid cells interact with nerve fibres. However, it is unclear whether this new understanding has informed the study of human chronic pain. In this article, we perform a scoping review investigating neuroimmune interactions between myeloid cells and peripheral nerve fibres in human chronic pain conditions. We found 37 papers from multiple pain states addressing this aim in skin, cornea, peripheral nerve, endometrium, and tumour, with macrophages, Langerhans cells, and mast cells the most investigated. The directionality of results between studies was inconsistent, although the clearest pattern was an increase in macrophage frequency across conditions, phases, and tissues. Myeloid cell definitions were often outdated and lacked correspondence with the stated cell types of interest; overreliance on morphology and traditional structural markers gave limited insight into the functional characteristics of investigated cells. We therefore critically reappraise the existing literature considering contemporary myeloid cell biology and advocate for the application of established and emerging high-dimensional proteomic and transcriptomic single-cell technologies to clarify the role of specific neuroimmune interactions in chronic pain.
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Affiliation(s)
- Jayden A O'Brien
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jackson F Karrasch
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Yun Huang
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erica E Vine
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Anthony L Cunningham
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Andrew N Harman
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Paul J Austin
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, Australia
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Li CMF, Muccilli A, Climans SA, Shoesmith C, Pandey S, Foster C, Pejhan S, Sangle N, Hammond R. Clinical Neuropathology Conference: "It's Getting on My Nerves". Can J Neurol Sci 2024; 51:293-299. [PMID: 37496444 DOI: 10.1017/cjn.2023.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Cathy Meng Fei Li
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Alexandra Muccilli
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Seth A Climans
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Sachin Pandey
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Diagnostic Imaging, London Health Sciences Centre, Western University, London, ON, Canada
| | - Cheryl Foster
- Department of Medicine (Hematology), London Health Sciences Centre, Western University, London, ON, Canada
| | - Shervin Pejhan
- Department of Pathology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Nikhil Sangle
- Department of Pathology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Robert Hammond
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Pathology, London Health Sciences Centre, Western University, London, ON, Canada
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3
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Shomal Zadeh F, Khan AK, Pooyan A, Alipour E, Azhideh A, Chalian M. Sciatic diffuse large B-cell lymphoma with treatment response to CHOP and radiotherapy. Radiol Case Rep 2024; 19:207-212. [PMID: 38028295 PMCID: PMC10651427 DOI: 10.1016/j.radcr.2023.10.027] [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: 09/14/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Neurolymphomatosis is an uncommon presentation of lymphoma caused by the infiltration of the peripheral nervous system by lymphoid cells. Here, we describe a case of neurolymphomatosis of the sciatic nerve in 41-year-old woman, which presented by acute onset pain and progress to paresthesia and weakness. Magnetic resonance imaging (MRI) revealed lobulated mass involving the right sciatic nerve with central necrosis and mild surrounding edema, which was isointense on T1-weighted images, hyperintense on short tau inversion recovery (STIR). Positron emission tomography and computed tomography (PET-CT) showed centrally necrotic mass with avid fluorodeoxyglucose (FDG) uptake in the right sciatic nerve. Partial resection of the tumor was done, and the diagnosis of the diffuse large B-cell lymphoma was made and confirmed by bone marrow biopsy. Patient was treated with R-CHOP chemotherapy (regimen consisting of cyclophosphamide, doxorubicin, prednisone, rituximab, and vincristine) and radiotherapy.
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Affiliation(s)
- Firoozeh Shomal Zadeh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Ayimen Khalid Khan
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Atefe Pooyan
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Ehsan Alipour
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Arash Azhideh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Majid Chalian
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
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Shelly S, Dubey D, Mills JR, Klein CJ. Paraneoplastic neuropathies and peripheral nerve hyperexcitability disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:239-273. [PMID: 38494281 DOI: 10.1016/b978-0-12-823912-4.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathy is a common referral for patients to the neurologic clinics. Paraneoplastic neuropathies account for a small but high morbidity and mortality subgroup. Symptoms include weakness, sensory loss, sweating irregularity, blood pressure instability, severe constipation, and neuropathic pain. Neuropathy is the first presenting symptom of malignancy among many patients. The molecular and cellular oncogenic immune targets reside within cell bodies, axons, cytoplasms, or surface membranes of neural tissues. A more favorable immune treatment outcome occurs in those where the targets reside on the cell surface. Patients with antibodies binding cell surface antigens commonly have neural hyperexcitability with pain, cramps, fasciculations, and hyperhidrotic attacks (CASPR2, LGI1, and others). The antigenic targets are also commonly expressed in the central nervous system, with presenting symptoms being myelopathy, encephalopathy, and seizures with neuropathy, often masked. Pain and autonomic components typically relate to small nerve fiber involvement (nociceptive, adrenergic, enteric, and sudomotor), sometimes without nerve fiber loss but rather hyperexcitability. The specific antibodies discovered help direct cancer investigations. Among the primary axonal paraneoplastic neuropathies, pathognomonic clinical features do not exist, and testing for multiple antibodies simultaneously provides the best sensitivity in testing (AGNA1-SOX1; amphiphysin; ANNA-1-HU; ANNA-3-DACH1; CASPR2; CRMP5; LGI1; PCA2-MAP1B, and others). Performing confirmatory antibody testing using adjunct methods improves specificity. Antibody-mediated demyelinating paraneoplastic neuropathies are limited to MAG-IgM (IgM-MGUS, Waldenström's, and myeloma), with the others associated with cytokine elevations (VEGF, IL6) caused by osteosclerotic myeloma, plasmacytoma (POEMS), and rarely angiofollicular lymphoma (Castleman's). Paraneoplastic disorders have clinical overlap with other idiopathic antibody disorders, including IgG4 demyelinating nodopathies (NF155 and Contactin-1). This review summarizes the paraneoplastic neuropathies, including those with peripheral nerve hyperexcitability.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Mouri N, Koike H, Fukami Y, Takahashi M, Yagi S, Furukawa S, Suzuki M, Kishimoto Y, Murate K, Nukui T, Yoshida T, Kudo Y, Tada M, Higashiyama Y, Watanabe H, Nakatsuji Y, Tanaka F, Katsuno M. Granuloma, vasculitis, and demyelination in sarcoid neuropathy. Eur J Neurol 2024; 31:e16091. [PMID: 37847215 DOI: 10.1111/ene.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Despite the suggestion that direct compression by granuloma and ischemia resulting from vasculitis can cause nerve fiber damage, the mechanisms underlying sarcoid neuropathy have not yet been fully clarified. METHODS We examined the clinicopathological features of sarcoid neuropathy by focusing on electrophysiological and histopathological findings of sural nerve biopsy specimens. We included 18 patients with sarcoid neuropathy who had non-caseating epithelioid cell granuloma in their sural nerve biopsy specimens. RESULTS Although electrophysiological findings suggestive of axonal neuropathy were observed, particularly in the lower limbs, all but three patients showed ≥1 abnormalities in nerve conduction velocity or distal motor latency. Additionally, a conduction block was observed in 11 of the 16 patients for whom waveforms were assessed; five of them fulfilled motor nerve conduction criteria strongly supportive of demyelination as defined in the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) guideline for chronic inflammatory demyelinating polyneuropathy (CIDP). In most patients, sural nerve biopsy specimens revealed a mild to moderate degree of myelinated fiber loss. Fibrinoid necrosis was observed in one patient, and electron microscopy analysis revealed demyelinated axons close to granulomas in six patients. CONCLUSIONS Patients with sarcoid neuropathy may meet the EAN/PNS electrophysiological criteria for CIDP due to the frequent presence of conduction blocks. Based on our results, in addition to the ischemic damage resulting from granulomatous inflammation, demyelination may play an important role in the mechanism underlying sarcoid neuropathy.
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Affiliation(s)
- Naohiro Mouri
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neurology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Yuki Fukami
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mie Takahashi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoru Yagi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soma Furukawa
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Kishimoto
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichiro Murate
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takamasa Nukui
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Tamaki Yoshida
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yosuke Kudo
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Mikiko Tada
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Srichawla BS, Bose A, Kipkorir V. Cranial neurolymphomatosis and its oncologic counterparts: Case series on malignant cranial nerve neuropathies. SAGE Open Med Case Rep 2023; 12:2050313X231221466. [PMID: 38162422 PMCID: PMC10757433 DOI: 10.1177/2050313x231221466] [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: 06/02/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Neurolymphomatosis occurs due to the infiltration of a nerve by malignant cells. Cranial neurolymphomatosis is a rare disease process associated with non-solid tumors (i.e., lymphoma, leukemia, etc.). Cranial neurolymphomatosis presents with single or multifocal neuropathy. Primary cranial neurolymphomatosis is defined as the initial presenting symptom leading to a new diagnosis of cancer. Secondary cranial neurolymphomatosis is defined as cancer progression with spread to a cranial nerve. While cranial neurolymphomatosis is a recognized cause of cranial nerve neuropathies, a myriad of other malignancies can also lead to similar clinical manifestations. This case series elucidates not only the classical presentations associated with cranial neurolymphomatosis but also introduces other oncologic entities that may compromise cranial nerve functions. A descriptive case series is presented on six patients with malignancy-related cranial neuropathy who came to a tertiary-care center from 2018 to 2022. 5/6 (83.3%) of patients presented with primary cranial neuropathy. Diffuse large B-cell lymphoma was the most prevalent malignancy observed in 3/6 (50.0%) cases. Other malignancies observed include non-Hodgkin lymphoma, monoclonal B-cell lymphocytosis, and peripheral T-cell lymphoma. The most affected cranial nerve was the trigeminal nerve in 4/6 (66.6%) individuals. Multiple cranial neuropathies were seen in 2/6 (33.3%) of patients. The most common neuroradiographic finding was a lesion to Meckel's cave. Other cranial nerves affected include the optic, facial, and vestibulocochlear nerves. Diagnostic modalities utilized included magnetic resonance imaging and 18F-fluoro-2-D-glucose positron emission tomography-computerized tomography. Cerebrospinal fluid analysis for flow cytometry may also have diagnostic value in patients with increased disease burden. Treatment was guided according to individual malignancy and 2/6 (33.3%) patients achieved complete remission, 2/6 (33.3%) died within 1 year, and 1/6 (16.6%) were referred to hospice. Cranial neuropathy may be the first symptom of a neoplastic process; thus, prompt recognition and treatment may improve morbidity and mortality.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abigail Bose
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Collins MP, Hadden RDM, Shahnoor N. Primary perineuritis, a rare but treatable neuropathy: Review of perineurial anatomy, clinicopathological features, and differential diagnosis. Muscle Nerve 2023; 68:696-713. [PMID: 37602939 DOI: 10.1002/mus.27949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
The perineurium surrounds each fascicle in peripheral nerves, forming part of the blood-nerve barrier. We describe its normal anatomy and function. "Perineuritis" refers to both a nonspecific histopathological finding and more specific clinicopathological entity, primary perineuritis (PP). Patients with PP are often assumed to have nonsystemic vasculitic neuropathy until nerve biopsy is performed. We systematically reviewed the literature on PP and developed a differential diagnosis for histopathologically defined perineuritis. We searched PubMed, Embase, Scopus, and Web of Science for "perineuritis." We identified 20 cases (11 M/9F) of PP: progressive, unexplained neuropathy with biopsy showing perineuritis without vasculitis or other known predisposing condition. Patients ranged in age from 18 to 75 (mean 53.7) y and had symptoms 2-24 (median 4.5) mo before diagnosis. Neuropathy was usually sensory-motor (15/20), painful (18/19), multifocal (16/20), and distal-predominant (16/17) with legs more affected than arms. Truncal numbness occurred in 6/17; 10/18 had elevated cerebrospinal fluid (CSF) protein. Electromyography (EMG) and nerve conduction studies (NCS) demonstrated primarily axonal changes. Nerve biopsies showed T-cell-predominant inflammation, widening, and fibrosis of perineurium; infiltrates in epineurium in 10/20 and endoneurium in 7/20; and non-uniform axonal degeneration. Six had epithelioid cells. 19/20 received corticosteroids, 8 with additional immunomodulators; 18/19 improved. Two patients did not respond to intravenous immunoglobulin (IVIg). At final follow-up, 13/16 patients had mild and 2/16 moderate disability; 1/16 died. Secondary causes of perineuritis include leprosy, vasculitis, neurosarcoidosis, neuroborreliosis, neurolymphomatosis, toxic oil syndrome, eosinophilia-myalgia syndrome, and rarer conditions. PP appears to be an immune-mediated, corticosteroid-responsive disorder. It mimics nonsystemic vasculitic neuropathy. Cases with epithelioid cells might represent peripheral nervous system (PNS)-restricted forms of sarcoidosis.
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Affiliation(s)
- Michael P Collins
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Nazima Shahnoor
- Neuromuscular Pathology Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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8
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Beydoun SR, Darki L. Paraproteinemic Neuropathies. Continuum (Minneap Minn) 2023; 29:1492-1513. [PMID: 37851040 DOI: 10.1212/con.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Coexistence of polyneuropathy and gammopathy is a common but potentially challenging situation in clinical practice. This article reviews the clinical, electrophysiologic, and hematologic phenotypes of the paraproteinemic neuropathies and the diagnostic and treatment strategies for each. LATEST DEVELOPMENTS Advances in our understanding of the underlying pathophysiology of various paraproteinemic neuropathies and their corresponding phenotypes have identified potential new therapeutic targets. Therapeutic strategies to diminish anti-myelin-associated glycoprotein (MAG) IgM antibodies have shown partial and inconsistent efficacy; however, antigen-specific immune therapy is being investigated as a novel treatment to remove the presumably pathogenic anti-MAG antibody. Advances in genetic and cell signaling studies have resulted in the approval of Bruton tyrosine kinase inhibitors for Waldenström macroglobulinemia. Monoclonal antibodies are being investigated for the treatment of light chain amyloidosis. ESSENTIAL POINTS Early recognition and treatment of underlying plasma cell disorders improves clinical outcomes in patients with paraproteinemic neuropathy. Despite significant progress, our knowledge regarding underlying mechanisms for paraproteinemic neuropathy is still limited. Clinicians' awareness of clinical phenotypes, electrophysiologic hallmarks, and hematologic findings of the different paraproteinemic neuropathies is crucial to promptly identify and treat patients and to avert misdiagnosis. Multidisciplinary collaboration among specialists, including neurologists and hematologists, is paramount for the optimal treatment of these patients with overlapping conditions.
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9
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Chen Y, Wang Y, Corrigan J, Memon AB. B-Cell Lymphoma Presenting With Seventh Cranial Nerve Palsy and Mononeuritis Multiplex: A Case Report and Comprehensive Literature Review. Cureus 2023; 15:e44983. [PMID: 37822434 PMCID: PMC10564262 DOI: 10.7759/cureus.44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
Diagnosing B-cell lymphoma-associated mononeuritis multiplex is challenging due to its rarity and the potential co-existence of other causes of mononeuritis multiplex. Here, we report a case of a 74-year-old male who initially presented with left cranial neuropathies followed by right-sided extremity weakness with hyporeflexia, right facial involvement, and subsequently asymmetric weakness and multifocal muscle wasting. Minor improvements were observed with multiple rounds of steroid treatment. The diffuse large B-cell lymphoma diagnosis was eventually established six months later upon a repeat mediastinal lymph node biopsy and cerebrospinal fluid cytology. A nerve biopsy demonstrated severe axonal neuropathy with loss of axons in all fascicles without evidence of vasculitis. A muscle biopsy showed atrophy in both type 1 and type 2 fibers. A presentation of mononeuritis multiplex warrants concern for B-cell lymphoma, mainly when other mechanisms of peripheral neuropathy are less likely.
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Affiliation(s)
- Yongzhen Chen
- School of Medicine, Saint Louis University, Saint Louis, USA
| | - Yilun Wang
- School of Medicine, Texas Agricultural and Mechanical (A&M) University, Bryan, USA
| | - John Corrigan
- Department of Radiology, Henry Ford Health System, Detroit, USA
- School of Medicine, Wayne State University, Detroit, USA
| | - Anza B Memon
- Department of Neurology, John D. Dingell Veterans Affairs Medical Center, Detroit, USA
- School of Medicine, Wayne State University, Detroit, USA
- Department of Neurology, Henry Ford Health System, Detroit, USA
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10
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Wada A, Uchida Y, Hokkoku K, Kondo A, Fujii Y, Chiba T, Matsuo T, Tsukamoto H, Hatanaka Y, Kobayashi S, Sonoo M. Utility of nerve ultrasound in the management of primary neurolymphomatosis: Case report and review of the literature. Clin Neurophysiol Pract 2023; 8:92-96. [PMID: 37255717 PMCID: PMC10225816 DOI: 10.1016/j.cnp.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Primary neurolymphomatosis (NL) is a critical differential diagnosis of asymmetric multiple mononeuropathy and radiculoplexopathy. Its diagnosis is often challenging due to the lack of typical clinical signs of systemic lymphoma. We report a case of primary NL where nerve ultrasound (NUS) played an important role in the diagnosis and follow-up of the disease. Case presentation A 52-year-old man developed asymmetric painful multiple mononeuropathy in the right upper limb with cranial nerve involvement. After being referred to our department, the patient underwent NUS, which revealed marked enlargement and increased vascularity in the right upper limb nerves, brachial plexus, and cervical nerve roots. Furthermore, an epineural hypoechoic mass, a characteristic finding of NL, was seen in the right median nerve. These NUS findings prompted us to perform 18F-fluorodeoxyglucose positron emission tomography/computed tomography and a subsequent biopsy on the right axillary lymph node, confirming NL. Notably, the NUS abnormalities dramatically subsided, demonstrating the effectiveness of chemotherapy. Discussion The diagnostic utility of NUS for NL has been documented by many recent reports. Additionally, NUS can work as a quick follow-up tool for NL, as seen in our case.
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Affiliation(s)
- Arena Wada
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Yudai Uchida
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Amuro Kondo
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Yuki Fujii
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Takashi Chiba
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Takuji Matsuo
- Department of Hematology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | | | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Shunsuke Kobayashi
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
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11
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Fan Y, Zeng GH, Xiao W, Yu JM, Zhang XD. Mature B-cell lymphoma with acute myelitis as the first presentation: a case report and literature review. BMC Neurol 2023; 23:111. [PMID: 36932413 PMCID: PMC10022169 DOI: 10.1186/s12883-023-03164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Lymphomas are malignant tumors of the immune system that arise in lymphoid organs and can impact the central nervous system. However, lymphomas with acute myelitis as the first manifestation are exceedingly rare, and most of them are symptoms of spinal cord damage due to the lack of specificity in their clinical manifestations. The rate of early misdiagnosis is exceedingly high, and the prognosis is dire. Here, we report a case of mature B-cell lymphoma with acute myelitis as the first presentation and review the related literature. CASE PRESENTATION In this study, We report a case of a 70-year-old male patient with bilateral lower extremity weakness, bowel and bladder dysfunction, and recurrent fever. A paraureteral mass was seen beneath the right kidney on imaging, and the final pathological biopsy revealed: CD20 ( +), mature B-cell tumor, The patient refused to undergo additional tests to ascertain the type of lymphoma and subsequent therapy and asked to be discharged. In mid-November 2020, the patient died. CONCLUSIONS This case report shows that patients with lymphoma can present with acute myelitis as the first symptom, especially if they have recurrent fever, that conventional treatment for myelitis is ineffective, and that tumors are considered after other causes of myelitis have been ruled out. Furthermore, a focused search for tumor-related evidence, as well as early identification and therapy, may help patients live longer lives.
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Affiliation(s)
- Yang Fan
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Gen-Hui Zeng
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Wei Xiao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ju-Ming Yu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiao-Dong Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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12
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Ducatel P, Michaud M, Viala K, Leblond V, Charlotte F, Roos-Weil D, Benoit C, Debs R, Maisonobe T. Neurolymphomatosis: involvement of peripheral nervous system revealing hematologic malignancy, a report of nine cases. J Peripher Nerv Syst 2023. [PMID: 36861226 DOI: 10.1111/jns.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND AND AIM Neurolymphomatosis is defined as an infiltration of the peripheral nervous system (PNS) by malignant lymphoma cells. It is a rare entity and diagnosis is complicated especially when PNS involvement is the initial and leading symptom. To improve knowledge of the disorder and shorten the time to diagnosis, we report a series of nine patients without a history of hematologic malignancy, who were diagnosed with neurolymphomatosis after evaluation and workup of peripheral neuropathy. METHODS The patients were included from the Department of Clinical Neurophysiology at Pitié Salpêtrière and Nancy Hospitals over a period of 15 years. Diagnosis of neurolymphomatosis was confirmed by histopathologic examination for each patient. We characterized their clinical, electrophysiological, biological, imaging, and histopathologic features. RESULTS The neuropathy was characterized by pain (78%), proximal involvement (44%) or of all four limbs (67%), asymmetrical or with multifocal distribution (78%), abundant fibrillation (78%), a tendency to worsen rapidly, and significant associated weight loss (67%). Neurolymphomatosis was diagnosed principally on nerve biopsy (89%) identifying infiltration of lymphoid cells, atypical cells (78%), a monoclonal population (78%), and supported by fluorodeoxyglucose-positron emission tomography, spine or plexus MRI, cerebrospinal fluid analysis, and blood lymphocyte immunophenotyping. Six patients had systemic disease and three impairment limited to the PNS. In the latter case, progression could be unpredictable and may be diffuse and explosive, sometimes occurring years after a seemingly indolent course. INTERPRETATION This study provides better knowledge and understanding of neurolymphomatosis when neuropathy is the initial presentation.
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Affiliation(s)
- Pauline Ducatel
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Maud Michaud
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karine Viala
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Véronique Leblond
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Frédéric Charlotte
- Département d'Anatomopathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Roos-Weil
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Charline Benoit
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Département de Neuropathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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13
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Magy L, Duchesne M, Frachet S, Vallat JM. Neuropatie periferiche. Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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14
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Neurolymphomatosis of cranial nerves as the responsible lesions for the vocal cord paralysis and facial nerve palsy in a patient with diffuse large B-cell lymphoma. Ann Hematol 2023; 102:481-482. [PMID: 36374340 DOI: 10.1007/s00277-022-05038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
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15
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Liang W, Wang Y, Sun W, Li D, Zhang X, Zhu P, Zhu Z, Fang Y. Persistent pain and numbness in the extremities of an adult due to paraneoplastic peripheral neuropathy caused by olfactory neuroblastoma: A case report. Front Neurol 2023; 13:1002076. [PMID: 36698887 PMCID: PMC9868692 DOI: 10.3389/fneur.2022.1002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Paraneoplastic peripheral neuropathy (PPN) caused by olfactory neuroblastoma (ONB) has not yet been reported. Case report We present a rare case of an adult who hospitalized repeatedly over the past 9 months for persistent pain and numbness in the limbs. This patient was initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) and treated accordingly, but neurological symptoms did not improve significantly. After this admission, FDG-PET/CT showed focal hypermetabolism of a soft-tissue mass in the nasal cavity, and further lesion biopsy suggested ONB. Combined with positive serum anti-Hu antibody, the diagnosis of PPN associated with ONB was eventually made. Furthermore, the patient's neurological symptoms were relieved after removal of the primary tumor, confirming the accuracy of the diagnosis. Conclusion Our case not only expanded the clinical characteristics of ONB but also highlighted the importance of early and comprehensive tumor screening for the diagnosis of PPN.
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Affiliation(s)
- Wenwen Liang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanyan Wang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenzhe Sun
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dongrui Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoping Zhang
- Department of Infection, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pengcheng Zhu
- Department of Pathology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhou Zhu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Zhou Zhu ✉
| | - Yongkang Fang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China,Yongkang Fang ✉
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16
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Fargeot G, Gitiaux C, Magy L, Pereon Y, Delmont E, Viala K, Echaniz-Laguna A. French recommendations for the management of adult & pediatric chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Rev Neurol (Paris) 2022; 178:953-968. [PMID: 36182621 DOI: 10.1016/j.neurol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system, primarily affecting the myelin sheath. The pathophysiology of CIDP is complex, involving both humoral and cellular immunity. The diagnosis of CIDP should be suspected in patients with symmetrical proximal and distal motor weakness and distal sensory symptoms of progressive onset, associated with decreased/abolished tendon reflexes. Treatments include intraveinous immunoglobulins, steroids and plasma exchange, with usually an induction phase followed by a maintenance therapy with progressive weaning. Treatment should be rapidly initiated to prevent axonal degeneration, which may compromise recovery. CIDP outcome is variable, ranging from mild distal paresthesiae to complete loss of ambulation. There have been several breakthroughs in the diagnosis and management of CIDP the past ten years, e.g. discovery of antibodies against the node of Ranvier, contribution of nerve ultrasound and magnetic resonance imaging to diagnosis, and demonstration of subcutaneous immunoglobulins efficiency. This led us to elaborate French recommendations for the management of adult & pediatric CIDP patients. These recommendations include diagnosis assessment, treatment, and follow-up.
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Affiliation(s)
- G Fargeot
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
| | - C Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - L Magy
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges, Limoges, France
| | - Y Pereon
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, Explorations Fonctionnelles, Hôtel-Dieu, Nantes, France
| | - E Delmont
- Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France
| | - K Viala
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Echaniz-Laguna
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France; Inserm U1195, Paris-Saclay University, Le-Kremlin-Bicêtre, France
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17
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Cerri F, Gentile F, Clarelli F, Santoro S, Falzone YM, Dina G, Romano A, Domi T, Pozzi L, Fazio R, Podini P, Sorosina M, Carrera P, Esposito F, Riva N, Briani C, Cavallaro T, Filippi M, Quattrini A. Clinical and pathological findings in neurolymphomatosis: Preliminary association with gene expression profiles in sural nerves. Front Oncol 2022; 12:974751. [PMID: 36226068 PMCID: PMC9549065 DOI: 10.3389/fonc.2022.974751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Although inflammation appears to play a role in neurolymphomatosis (NL), the mechanisms leading to degeneration in the peripheral nervous system are poorly understood. The purpose of this exploratory study was to identify molecular pathways underlying NL pathogenesis, combining clinical and neuropathological investigation with gene expression (GE) studies. We characterized the clinical and pathological features of eight patients with NL. We further analysed GE changes in sural nerve biopsies obtained from a subgroup of NL patients (n=3) and thirteen patients with inflammatory neuropathies as neuropathic controls. Based on the neuropathic symptoms and signs, NL patients were classified into three forms of neuropathy: chronic symmetrical sensorimotor polyneuropathy (SMPN, n=3), multiple mononeuropathy (MN, n=4) and acute motor-sensory axonal neuropathy (AMSAN, n=1). Predominantly diffuse malignant cells infiltration of epineurium was present in chronic SMPN, whereas endoneurial perivascular cells invasion was observed in MN. In contrast, diffuse endoneurium malignant cells localization occurred in AMSAN. We identified alterations in the expression of 1266 genes, with 115 up-regulated and 1151 down-regulated genes, which were mainly associated with ribosomal proteins (RP) and olfactory receptors (OR) signaling pathways, respectively. Among the top up-regulated genes were actin alpha 1 skeletal muscle (ACTA1) and desmin (DES). Similarly, in NL nerves ACTA1, DES and several RPs were highly expressed, associated with endothelial cells and pericytes abnormalities. Peripheral nerve involvement may be due to conversion towards a more aggressive phenotype, potentially explaining the poor prognosis. The candidate genes reported in this study may be a source of clinical biomarkers for NL.
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Affiliation(s)
- Federica Cerri
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Gentile
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ferdinando Clarelli
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Yuri Matteo Falzone
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giorgia Dina
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Romano
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Fazio
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Paola Podini
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Melissa Sorosina
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Paola Carrera
- Division of Genetics and Cell Biology and Laboratory of Clinical Molecular Biology and Cytogenetics, Unit of Genomics for Human Disease Diagnosis, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Federica Esposito
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Nilo Riva, ; Angelo Quattrini,
| | - Chiara Briani
- Department of Neuroscience , University of Padova, Padova, Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Massimo Filippi
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Nilo Riva, ; Angelo Quattrini,
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18
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Hattori K, Matsuda N, Yoshizawa M, Ugawa Y, Kanai K. [Oculomotor nerve palsy with preserved pupillary reaction in two cases of neurolymphomatosis]. Rinsho Shinkeigaku 2022; 62:552-557. [PMID: 35753787 DOI: 10.5692/clinicalneurol.cn-001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Case 1: A 64-year-old woman with acute ptosis and diplopia was admitted to our hospital. She had right oculomotor nerve palsy with preserved pupillary reaction without any other neurological deficits. MRI showed abnormal enhancement in the right oculomotor nerve. An ovarian tumor was detected on CT examination, and was pathologically diagnosed as diffuse large B-cell lymphoma (DLBCL). Cerebrospinal fluid cytology disclosed malignant lymphoma cells. Based on the above findings, we concluded that she had neurolymphomatosis (NL) of the right oculomotor nerve. Case 2: A 63-year-old woman was admitted to our hospital due to weakness of the bilateral lower extremities and gait disturbance. Lumbar MRI showed enhanced lesions in the cauda equina, and we diagnosed her as having DLBCL based on bone marrow aspiration study. She later developed right oculomotor nerve palsy with preserved pupillary reaction together with the right abducens and hypoglossal nerve palsies, which were caused by NL. Our cases suggest that oculomotor nerve palsy with preserved pupillary reaction can be a clinical feature of NL. Although NL mainly affects the subperinerium, as parasympathetic fibers are located in the periphery of the oculomotor nerve and supplied by pia matar blood vessels, patients with NL may shows this clinical feature.
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Affiliation(s)
| | | | | | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University
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19
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Ando T, Kamoshita S, Riku Y, Ito A, Ozawa Y, Miyamura K, Fujino M, Ito M, Goto Y, Mano K, Akagi A, Miyahara H, Katsuno M, Yoshida M, Iwasaki Y. Neurolymphomatosis in follicular lymphoma: an autopsy case report. Neuropathology 2022; 42:295-301. [PMID: 35607714 DOI: 10.1111/neup.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/02/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Neurolymphomatosis is a neurological manifestation of lymphoma that involves the cranial or spinal peripheral nerves, nerve roots, and plexus with direct invasion of neoplastic cells. Neurolymphomatosis is rare among patients with low-grade lymphoma. We report an autopsied case of neurolymphomatosis that arose from follicular lymphoma. A 49-year-old woman who presented with pain of her neck and shoulder and numbness of her chin. Computed tomography revealed enlarged lymph nodes in her whole body, and biopsy from the axillary lymph node revealed grade 2 follicular lymphoma. Although the patient underwent chemotherapy, she gradually developed muscle weakness in the upper limbs and sensory disturbances of the trunk and limbs. 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed increased tracer uptake of the cervical nerve roots. Repeated FDG-PET after additional therapy revealed progression of disease within the nerve roots and brachial plexus, whereas gadolinium-contrast magnetic resonance imaging (MRI) showed weak enhancement of the cervical nerve roots without formation of mass lesions. She died after a total disease duration of 12 months. Postmortem observations revealed invasion of lymphoma cells into the cervical nerve roots, dorsal root ganglia, and subarachnoid spaces of the spinal cord. Neurolymphomatosis was prominent at the segments of C6-Th2. Combined loss of axons and myelin sheaths was observed in the cervical nerve roots and posterior columns. Lymphoma cells also invaded the cranial nerves. The subarachnoid and perivascular spaces of the brain demonstrated focal invasion of the lymphoma. Mass lesions were not observed in the central nervous system. The lymphoma cells did not show histological transformation to higher grades, and the density of the centroblasts remained at grade 2. Our report clarifies that low-grade follicular lymphoma can manifest as neurolymphomatosis and central nervous system invasion in the absence of transformation toward higher histological grades. FDG-PET may be more sensitive to non-mass-forming lesions, including neurolymphomatosis, than gadolinium-contrast MRI.
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Affiliation(s)
- Takashi Ando
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Sonoko Kamoshita
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuichi Riku
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Ai Ito
- Department of Pathology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masahiko Fujino
- Department of Pathology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoji Goto
- Department of Neurology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Kazuo Mano
- Department of Neurology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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20
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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21
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Kim S, Lee MW, Choi SY, Sohn EH. Chronic demyelinating polyneuropathy preceding T-cell lymphoma: differentiation between primary neurolymphomatosis and paraneoplastic neuropathy. BMJ Case Rep 2022; 15:e247127. [PMID: 35418377 PMCID: PMC9013955 DOI: 10.1136/bcr-2021-247127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man presented with progressive asymmetric weakness and pain. Electrodiagnostic tests and nerve biopsy suggested chronic demyelinating polyneuropathy refractory to immune-modulating therapy. The patient's symptoms were aggravated, and he was finally diagnosed with T-cell lymphoma based on the findings of the second 18F-2 fluoro-2-deoxy-glucose positron emission tomography/CT performed 16 months after symptom onset. The patient received intravenous chemotherapy, but died 2 months later because of lymphoma progression. A clinical suspicion of neurolymphomatosis and early diagnosis are important for proper management.
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Affiliation(s)
- Sooyoung Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myoung-Won Lee
- Department of Hematology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Song-Yi Choi
- Department of Pathology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
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22
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Koike H, Furukawa S, Mouri N, Fukami Y, Iijima M, Katsuno M. Dosage effects of PMP22 on nonmyelinating Schwann cells in hereditary neuropathy with liability to pressure palsies. Neuromuscul Disord 2022; 32:503-511. [DOI: 10.1016/j.nmd.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
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23
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From Biology to Treatment of Monoclonal Gammopathies of Neurological Significance. Cancers (Basel) 2022; 14:cancers14061562. [PMID: 35326711 PMCID: PMC8946535 DOI: 10.3390/cancers14061562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 12/23/2022] Open
Abstract
Monoclonal gammopathy and peripheral neuropathy are common diseases of elderly patients, and almost 10% of patients with neuropathy of unknown cause have paraprotein. However, growing evidence suggests that several hematological malignancies synthesize and release monoclonal proteins that damage the peripheral nervous system through different mechanisms. The spectrum of the disease varies from mild to rapidly progressive symptoms, sometimes affecting not only sensory nerve fibers, but also motor and autonomic fibers. Therefore, a multidisciplinary approach, mainly between hematologists and neurologists, is recommended in order to establish the correct diagnosis of monoclonal gammopathy of neurological significance and to tailor therapy based on specific genetic mutations. In this review, we summarize the spectrum of monoclonal gammopathies of neurological significance, their distinctive clinical and neurophysiological phenotypes, the most relevant pathophysiological events and new therapeutic approaches.
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24
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Lozeron P. Polineuropatie infiammatorie demielinizzanti croniche. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Karam C. Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Five New Things. Neurol Clin Pract 2022; 12:258-262. [DOI: 10.1212/cpj.0000000000001150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022]
Abstract
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), while rare and heterogeneous, is one of the most common immune mediated neuropathies. CIDP, however, especially CIDP variants, can be difficult to diagnose. (1) There is no gold standard testing for CIDP, and, while a few specific disease-associated antibodies have been described, these are absent in the majority of patients. Furthermore, many experts consider the presence of these antibodies to be indicative of a separate disease. (2) Ultimately, CIDP remains a diagnosis of exclusion. Mimics are ruled out either by history or additional ancillary testing. Following experts’ guidelines on the diagnosis of CIDP increases significantly the accuracy of diagnosis. On a different note, while most patients with CIDP respond well to treatment, some may not tolerate therapy, and other may be refractory to first line treatments. In this review, we discuss 5 new things related to CIDP: 1) the updated European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) CIDP guidelines, 2) the expansion of the Chronic Immune Sensory Polyradiculopathy (CISP) spectrum, 3) updates in therapy for CIDP, 4) antibodies testing, serum neurofilament light chain and their role, and 5) disorders that can mimic CIDP.
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Goedee HS, Rajabally YA. Evidence base for investigative and therapeutic modalities in chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. Neurodegener Dis Manag 2022; 12:35-47. [PMID: 35007438 DOI: 10.2217/nmt-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy, its variants and multifocal motor neuropathy belong to a spectrum of peripheral nerve disorders with complex dysimmune disease mechanisms. Awareness of the unique clinical phenotypes but also heterogeneity between patients is vital to arrive at early suspicion and ordering appropriate tests. This includes requirements for optimal electrodiagnostic protocol, aimed to capture sufficient electrophysiologic evidence for relevant abnormalities, a case-based approach on the eventual need to further expand the diagnostic armamentarium and correct reading of their results. Considerable phenotypical variation, diverse combinations of abnormalities found on diagnostic tests and heterogeneity in disease course and treatment response, all contribute to widespread differences in success rates on timely diagnosis and optimal treatment. We aim to provide a practical overview and guidance on relevant diagnostic and management strategies, including pitfalls and present a summary of the relevant novel developments in this field.
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Affiliation(s)
- Hendrik Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology & Neurosurgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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27
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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28
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Kajtazi NI, Khalid E, AlGhamdi J, Altaf S, AlHameed MH. Chronic inflammatory demyelinating polyneuropathy evolving to primary CNS lymphoma. BMJ Case Rep 2021; 14:e244767. [PMID: 34728507 PMCID: PMC8565527 DOI: 10.1136/bcr-2021-244767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman presented with 3 months history of all four limbs' numbness in glove and stocking distribution. A week before admission, she developed all four limbs' weakness and numbness. Brain and whole spine imaging revealed no lesions, and cerebrospinal fluid showed high protein. A nerve conduction study revealed severe sensorimotor polyneuropathy, and she was diagnosed with chronic inflammatory demyelinating polyneuropathy. We treated her with plasma exchange and later developed bilateral pulmonary embolism, deep venous thrombosis and worsening of weakness. The second set of seven sessions of plasma exchange gave her improvement in muscle strength. However, after a chest infection, another neurological deterioration occurred. The third set of plasma exchanges resulted in excellent response. Nineteen months into her illness she developed a headache followed by left upper limb weakness and focal seizures with left side involvement. Brain imaging revealed a right frontal enhancing lesion that required resection, and biopsy showed diffuse large B-cell lymphoma. She was treated with chemotherapy and whole-brain radiation therapy and remained with left-sided weakness.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ehtesham Khalid
- Department of Neurology, Ideal Medicare Clinic, Multan, Pakistan
| | - Juman AlGhamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Syed Altaf
- Department of Hematology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed H AlHameed
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
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Fargeot G, Maisonobe T, Vandendries C, Le Garff-Tavernier M, Leblond V, Viala K. Neurolymphomatosis related to direct epineural invasion of the superficial peroneal nerve from subcutaneous B-cell lymphoma. Clin Neurol Neurosurg 2021; 210:106992. [PMID: 34700275 DOI: 10.1016/j.clineuro.2021.106992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Neurolymphomatosis is a rare complication of systemic lymphomas, and is classically related to hematogenous spread or intraneural spread of tumor cells from the leptomeninges. Here we report a case of neurolymphomatosis related to direct epineural invasion of the superficial peroneal nerve from subcutaneous localization of B-cell lymphoma. Nerve biopsy revealed striking histological features suggestive of contiguous infiltration of the superficial peroneal nerve by subcutaneous lymphoma. We think this case report sheds new light on neurolymphomatosis pathophysiology with an unreported mechanism in B-cell lymphoma. It also points out that the clinical spectrum in neurolymphomatosis is really variable, pure sensory mononeuritis being a rare presentation. Finally, our case is also strongly illustrative of the contribution of early nerve ultrasonography in the patient diagnosis and in guidance of the nerve biopsy.
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Affiliation(s)
- G Fargeot
- Department of Clinical Neurophysiology, Sorbonne Université, Hôpital Pitié Salpêtrière, APHP, Paris, France.
| | - T Maisonobe
- Department of Clinical Neurophysiology, Sorbonne Université, Hôpital Pitié Salpêtrière, APHP, Paris, France; Department of Neuropathology, Sorbonne Université, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - C Vandendries
- RMX-medical center, 80, avenue Felix-Faure, 75015 Paris, France
| | - M Le Garff-Tavernier
- Service d'hématologie biologique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - V Leblond
- Hematology Department, Sorbonne Université, Hôpital Pitié Salpêtrière APHP, Paris, France
| | - K Viala
- Department of Clinical Neurophysiology, Sorbonne Université, Hôpital Pitié Salpêtrière, APHP, Paris, France
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30
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Deschamps N, Mathis S, Duchesne M, Ghorab K, Gallouedec G, Richard L, Boulesteix JM, Corcia P, Magy L, Vallat JM. CIDP and hemopathies, an underestimated association. J Neurol Sci 2021; 429:118055. [PMID: 34455207 DOI: 10.1016/j.jns.2021.118055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated and treatable disease that may be associated with various systemic conditions. Our objective is to describe the clinical, electrophysiological and pathological data of a series of patients with both CIDP and hemopathy. In this retrospective study, we analyzed 21 patients with CIDP and various hemopathies (malignant or not), consecutively observed for almost five years. In this particular context (with a risk of neurological complications of the hemopathy), a nerve biopsy was taken from each patient (after written consent). All the patients fulfilled the EAN/PNS electrodiagnostic criteria (2021) of CIDP: 16 with 'CIDP' and 2 with 'possible CIDP' (no data for 3 patients). For each patient, pathological analysis of nerve biopsy was compatible with the diagnosis of CIDP, and there was no evidence for hematological complication of the peripheral nervous system. In cases of peripheral neuropathy and malignant hemopathy, the possibility that the peripheral neuropathy is CIDP should not be overlooked because CIDP is clearly accessible to appropriate therapies, with high potential for a positive clinical response. If the diagnosis of CIDP is usually suspected clinically and electrophysiologically, it should be confirmed by pathological study (nerve biopsy) in certain cases. The management of such patients benefits from the collaboration of neurologists, hematologists and oncologists.
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Affiliation(s)
- Nathalie Deschamps
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, AOC National Reference Center for Neuromuscular Disorders, ALS Center, University Hospital of Bordeaux (CHU Bordeaux - Pellegrin Hospital), place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Mathilde Duchesne
- Department of Pathology, University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Karima Ghorab
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Gaël Gallouedec
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Laurence Richard
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Jean-Marc Boulesteix
- Department of Neurology, Cahors Hospital (CH Cahors), 335 rue Wilson, 46005 Cahors, France
| | - Philippe Corcia
- Department of Neurology, ALS Center, University Hospital of Tours (CHU Tours - Bretonneau Hospital), 2 boulevard Tonnellé, 37044 Tours, France
| | - Laurent Magy
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges - Dupuytren Hospital), 2 avenue Martin Luther King, 87042 Limoges, France.
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31
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Koike H, Katsuno M. Paraproteinemia and neuropathy. Neurol Sci 2021; 42:4489-4501. [PMID: 34529193 DOI: 10.1007/s10072-021-05583-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/28/2021] [Indexed: 12/16/2022]
Abstract
Paraproteinemia is associated with different peripheral neuropathies. The major causes of neuropathy correlated with paraproteinemia are the deposition of immunoglobulin in the myelin, represented by anti-myelin-associated glycoprotein (MAG) neuropathy; deposition of immunoglobulin or its fragment in the interstitium, represented by immunoglobulin light chain amyloidosis (AL amyloidosis); and paraneoplastic mechanisms that cannot be solely attributed to the deposition of immunoglobulin or its fragment, represented by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin change (POEMS) syndrome. Patients with anti-MAG neuropathy and POEMS syndrome present with slowing of nerve conduction parameters. This characteristic fulfills the electrodiagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP) defined by the European Academy of Neurology and Peripheral Nerve Society (EAN/PNS). Although direct damage caused by the deposition of amyloid can induce axonal damage in AL amyloidosis, some patients with this condition have features fulfilling the EAN/PNS electrodiagnostic criteria for CIDP. Conventional immunotherapies for CIDP, such as steroids, intravenous immunoglobulin, and plasma exchange, offer no or only minimal-to-modest benefit. Although rituximab can reduce the level of circulating autoantibodies, it may only be effective in some patients with anti-MAG neuropathy. Drugs including melphalan, thalidomide, lenalidomide, and bortezomib for POEMS syndrome and those including melphalan, thalidomide, lenalidomide, pomalidomide, bortezomib, ixazomib, and daratumumab for AL amyloidosis are considered. Since there will be more therapeutic options in the future, thereby enabling appropriate treatments for individual neuropathies, there is an increasing need for early diagnosis.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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32
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Sommer C, Carroll AS, Koike H, Katsuno M, Ort N, Sobue G, Vucic S, Spies JM, Doppler K, Kiernan MC. Nerve biopsy in acquired neuropathies. J Peripher Nerv Syst 2021; 26 Suppl 2:S21-S41. [PMID: 34523188 DOI: 10.1111/jns.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Antonia S Carroll
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology and Neurophysiology, St Vincent's Hospital, The University of NSW, Sydney, New South Wales, Australia
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nora Ort
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
| | - Steve Vucic
- Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judith M Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
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33
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Hamaguchi M, Kokubun N, Matsuda H, Onuma H, Aoki R, Takahashi W, Mitani K, Suzuki K. A case report of secondary neurolymphomatosis showing selective nerve infiltration and massive lumbar plexus enlargement. BMC Neurol 2021; 21:296. [PMID: 34311723 PMCID: PMC8314556 DOI: 10.1186/s12883-021-02330-5] [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: 11/05/2020] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a rare manifestation of malignant lymphoma that shows selective infiltration to the peripheral nervous system primarily or secondarily. We report a patient with secondary NL caused by germinal center B-cell (GCB)-type diffuse large B-cell lymphoma (DLBCL) who showed selective infiltration of the lumbar plexus to the spinal cord and massive nerve enlargement resulting in severe pain. Case presentation A 72-year-old female exhibited asymmetric motor and sensory impairments and pain in the lower limbs that progressed for five months. Magnetic resonance imaging (MRI) showed an enlarged lumbar plexus, which continued to the cauda equina via the L3 and L4 spinal nerves. Her symptoms gradually worsened. Ten months after the onset of symptoms, the enlarged cauda equina filled the spinal canal space, and the spinal cord was swollen. A cauda equina biopsy was performed, and she was diagnosed with GCB-type DLBCL with CD10 positivity. The primary tumor was found in a mammary cyst. The autopsy study did not show apparent infiltration, except in the nervous system. Conclusions Although there are many neurologic phenotypes of malignant lymphoma, the association between the cytological characteristics of lymphoma and the neurological phenotypes is still unclear. Several reports of CD10-positive secondary NL are available, whereas peripheral or central nervous tissue origin lymphoma cases are mostly negative for CD10. CD10 staining may be useful for distinguishing primary NL from secondary NL. NL often has a strong organotropism for peripheral nervous tissue, which makes early diagnosis challenging. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02330-5.
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Affiliation(s)
- Mai Hamaguchi
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan.
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Hadzki Matsuda
- Department of Neurosurgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Hiroki Onuma
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Reika Aoki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Wataru Takahashi
- Department of Hematology and Oncology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
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Abstract
Paraproteinaemic neuropathies comprise a heterogeneous group of neuro-haematological conditions with some distinct neurological, haematological and systemic phenotypes. The spectrum of disease varies from mild to severe, indolent to rapidly progressive and from small fibre sensory involvement to dramatic sensorimotor deficits. The haematological association may be overlooked, resulting in delayed treatment, disability, impaired quality of life and increased mortality. However, the presence of an irrelevant benign paraprotein can sometimes lead to inappropriate treatment. In this review, we outline our practical approach to paraproteinaemic disorders, discuss the utility and limitations of diagnostic tests and the distinctive clinical phenotypes and touch on the complex multidisciplinary management approaches.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,National Hospital for Neurology and Neurosurgery, London, UK
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35
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Vallat JM, Mathis S, Magy L. Diagnosis and treatment of chronic inflammatory demyelinating polyneuropathy: A "grand cru" of updated data. Eur J Neurol 2021; 28:3545-3546. [PMID: 34152068 DOI: 10.1111/ene.14989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jean-Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, Limoges, France
| | - Stéphane Mathis
- Department of Neurology (Nerve-Muscle Unit), AOC National Reference Center for Neuromuscular Disorders, ALS Center, University Hospital of Bordeaux (CHU Bordeaux), Pellegrin Hospital, Bordeaux, France
| | - Laurent Magy
- Department and Laboratory of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, Limoges, France
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36
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Lefland A, Proia AD, Shah S. Clinical Reasoning: A 64-Year-Old Man With Multiple Cranial Neuropathies. Neurology 2021; 97:e215-e221. [PMID: 33893198 DOI: 10.1212/wnl.0000000000012081] [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
Affiliation(s)
- Ariel Lefland
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC.
| | - Alan D Proia
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Suma Shah
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC
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37
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Broers MC, Bunschoten C, Drenthen J, Beck TAO, Brusse E, Lingsma HF, Allen JA, Lewis RA, van Doorn PA, Jacobs BC. Misdiagnosis and diagnostic pitfalls of chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2021; 28:2065-2073. [PMID: 33657260 PMCID: PMC8252611 DOI: 10.1111/ene.14796] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Abstract
Background and purpose The aim of this study was to determine the frequency of over‐ and underdiagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and to identify related diagnostic pitfalls. Methods We conducted a retrospective study in Dutch patients referred to the Erasmus University Medical Centre Rotterdam between 2011 and 2017 with either a diagnosis of CIDP or another diagnosis that was revised to CIDP. We used the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) 2010 diagnostic criteria for CIDP to classify patients into three groups: overdiagnosis, underdiagnosis, or confirmed diagnosis of CIDP. Clinical and laboratory features and treatment history were compared between groups. Results A referral diagnosis of CIDP was revised in 32% of patients (31/96; overdiagnosis). Of 81 patients diagnosed with CIDP, 16 (20%) were referred with another diagnosis (underdiagnosis). In the overdiagnosed patients, 20% of muscle weakness was asymmetric, 48% lacked proximal muscle weakness, 29% only had distal muscle weakness, 65% did not fulfil the electrodiagnostic criteria for CIDP, 74% had an elevated cerebrospinal fluid (CSF) protein level, and 97% had another type of neuropathy. In the underdiagnosed patients, all had proximal muscle weakness, 50% had a clinically atypical CIDP, all fulfilled the electrodiagnostic criteria for CIDP, and 25% had an increased CSF protein level. Conclusion Over‐ and underdiagnosis of CIDP is common. Diagnostic pitfalls include lack of attention to proximal muscle weakness as a diagnostic hallmark of CIDP, insufficient recognition of clinical atypical phenotypes, overreliance on CSF protein levels, misinterpretation of nerve conduction studies and poor adherence to electrodiagnostic criteria, and failure to exclude other causes of polyneuropathy.
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Affiliation(s)
- Merel C Broers
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carina Bunschoten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith Drenthen
- Department of Clinical Neurophysiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tiago A O Beck
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Allen
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Rotterdam, Rotterdam, The Netherlands
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38
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Alazawi S, Elomri H, Taha R, Bakr M, Abdelhamid MT, Szabados L, Yassin M, Sabah HE, Aboudi K, Ellahie A, Fadul A, Gameil A, Al Battah A, Fernyhough LJ. Neurolymphomatosis of the median nerve, optic nerve, L4 spinal nerve root and cauda equina in patients with B-cell malignancies: a case series. J Med Case Rep 2021; 15:133. [PMID: 33766128 PMCID: PMC7995761 DOI: 10.1186/s13256-021-02714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurolymphomatosis is rare. Neoplastic lymphocytes are seen to invade nerves (cranial or peripheral), nerve roots or other related structures in patients with hematological malignancy. It is a separate entity from central nervous system lymphoma. Neurolymphomatosis has most commonly been described in association with B-cell non-Hodgkin lymphoma. Neurolymphomatosis in the context of Burkitt lymphoma and the post-renal transplant setting has not been described before. CASE REPORTS We report for the first time in the Arabian Gulf countries and nearby Arab states four cases of neurolymphomatosis (one Asian, and the other 3 are from Arabic nationals) occurring between 2012 and 2017 involving the median nerve, optic nerve, nerve root and cauda equina in patients with Burkitt lymphoma, Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma. CONCLUSIONS Neurolymphomatosis is rare and can be difficult to diagnose by biopsy but reliably confirmed by a combined imaging approach. Prior treatment with high-dose dexamethasone might suppress 18F-fluorodeoxyglucose (FDG) activity and decrease the sensitivity of positron emission tomography/computed tomography (PET/CT). The prognosis is generally poor but using high-dose methotrexate as well as high-dose chemotherapy and autologous stem cell transplantation may be an effective way to treat neurolymphomatosis.
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Affiliation(s)
- S Alazawi
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
- Weill Cornell Medicine, Doha, Qatar.
| | - H Elomri
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - R Taha
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M Bakr
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M T Abdelhamid
- Department of Radiology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Medicine, Mansoura University, Mansoura, Egypt
| | - L Szabados
- Department of Radiology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M Yassin
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - H El Sabah
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - K Aboudi
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Ellahie
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Fadul
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Gameil
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | - A Al Battah
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - L J Fernyhough
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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Moshe-Lilie O, Ensrud E, Ragole T, Nizar C, Dimitrova D, Karam C. CIDP mimics: a case series. BMC Neurol 2021; 21:94. [PMID: 33639867 PMCID: PMC7916267 DOI: 10.1186/s12883-021-02118-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background To report our experience with a group of patients referred for refractory CIDP who fulfilled “definite” electrodiagnostic EFNS criteria for CIDP but were found to have an alternate diagnosis. Methods Patients who were seen between 2017 and 2019 for refractory CIDP that fulfilled “definite” electrodiagnostic ENFS criteria for CIDP, but had an alternate diagnosis, were included. Patients who correctly had CIDP, anti MAG neuropathy, or MMN with conduction block, were excluded from the study. Demographics, clinical and electrophysiological characteristics, pertinent workup, final alternate diagnoses, and outcomes were collected. Results Seven patients were included: POEMS (n = 5), CANOMAD (n = 1), and neurolymphomatosis (n = 1). Most patients reported neuropathic pain and leg swelling (n = 6) or significant weight loss (n = 4). All patients had a monoclonal protein, and most patients who were tested had an elevated VEGF and CSF cyto-albuminologic dissociation. Electrophysiology showed pronounced intermediate more than distal demyelination, and axonal loss in the lower extremities. Response to steroids or IVIG varied, but some patients did respond to these treatments, especially early in the disease. Conclusion Pain, systemic symptoms, suggestive electrophysiological findings, and/or a serum monoclonal protein should raise suspicion for CIDP mimics. Initial response to steroids or IVIG, over reliance on CSF, and electrophysiology findings can all be misleading.
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Affiliation(s)
- Orly Moshe-Lilie
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Erik Ensrud
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Ragole
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Chahin Nizar
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Diana Dimitrova
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Chafic Karam
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., 3 West Gates, Philadelphia, PA, 19104, USA.
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Noel N, Beaudonnet G, Cauquil C, Laurenge A, De Menthon M, Labeyrie C, Chrétien P, Adam C, Hacein-Bey-Abina S, Goujard C, Lambotte O, Adams D. Inflammatory demyelinating polyneuropathies and lymphoma: clues to diagnosis and therapy. Leuk Lymphoma 2021; 62:2000-2004. [DOI: 10.1080/10428194.2021.1889535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nicolas Noel
- Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes (IMVA), Université Paris Saclay, Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay-aux-Roses, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
| | - Guillemette Beaudonnet
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Unité de Neurophysiologie Clinique et Epileptologie (UNCE), Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service de Neurologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Alice Laurenge
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service de Neurologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mathilde De Menthon
- Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Céline Labeyrie
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service de Neurologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Pascale Chrétien
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service d’Immunologie Biologique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Clovis Adam
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service de Neuropathologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Salima Hacein-Bey-Abina
- Assistance Publique – Hôpitaux de Paris, Service d’Immunologie Biologique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- UTCBS, CNRS UMR 8258, INSERM U1022, Faculty of Pharmacy, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Cécile Goujard
- Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes (IMVA), Université Paris Saclay, Faculté de Médecine Paris Saclay, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay-aux-Roses, France
- Université Paris Sud, Le Kremlin Bicêtre, France
| | - David Adams
- Université Paris Sud, Le Kremlin Bicêtre, France
- National Reference Center for FAP and other rare Peripheral Neuropathies (NNERF), Le Kremlin Bicêtre, France
- Assistance Publique – Hôpitaux de Paris, Service de Neurologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Mechanisms of Nerve Damage in Neuropathies Associated with Hematological Diseases: Lesson from Nerve Biopsies. Brain Sci 2021; 11:brainsci11020132. [PMID: 33498362 PMCID: PMC7909400 DOI: 10.3390/brainsci11020132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Despite the introduction of non-invasive techniques in the study of peripheral neuropathies, sural nerve biopsy remains the gold standard for the diagnosis of several neuropathies, including vasculitic neuropathy and neurolymphomatosis. Besides its diagnostic role, sural nerve biopsy has helped to shed light on the pathogenic mechanisms of different neuropathies. In the present review, we discuss how pathological findings helped understand the mechanisms of polyneuropathies complicating hematological diseases.
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Koike H, Mouri N, Fukami Y, Iijima M, Matsuo K, Yagi N, Saito A, Nakamura H, Takahashi K, Nakae Y, Okada Y, Tanaka F, Sobue G, Katsuno M. Two distinct mechanisms of neuropathy in immunoglobulin light chain (AL) amyloidosis. J Neurol Sci 2021; 421:117305. [PMID: 33540321 DOI: 10.1016/j.jns.2020.117305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/28/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although polyneuropathy in patients with immunoglobulin light chain (AL) amyloidosis has been considered to be attributable to axonal degeneration resulting from amyloid deposition, patients with nerve conduction parameters indicating demyelination that mimics chronic inflammatory demyelinating polyneuropathy (CIDP) have also been reported anecdotally. METHODS We evaluated the electrophysiological and pathological features of 8 consecutive patients with AL amyloidosis who were referred for sural nerve biopsy. RESULTS Although findings of axonal neuropathy predominantly in the lower limbs were the cardinal feature, all patients showed one or more abnormalities of nerve conduction velocities or distal motor latencies. In particular, 2 of these patients fulfilled the definite electrophysiological for CIDP defined by the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS). On electron microscopic examination of sural nerve biopsy specimens, Schwann cells apposed to amyloid fibrils became atrophic in all patients, suggesting that amyloid deposits directly affect neighboring tissues. Additionally, detachment of the neurilemma from the outermost compacted myelin lamella was seen where amyloid fibrils were absent in 4 patients. Electrophysiological findings suggestive of demyelination were more conspicuous in these patients compared with the other patients. The detachment of the neurilemma from the outermost compacted myelin lamella was particularly conspicuous in patients who fulfilled the definite EFNS/PNS electrophysiological criteria for CIDP. CONCLUSION Abnormalities of myelinated fibers unrelated to amyloid deposition may frequently occur in AL amyloidosis. Disjunction between myelin and the neurilemma may induce nerve conduction abnormalities suggestive of demyelination.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Naohiro Mouri
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Fukami
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Iijima
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Matsuo
- Department of Neurology, Kariya Toyota General Hospital, Aichi, Japan
| | - Nobuyasu Yagi
- Department of Neurology, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Asami Saito
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Haruko Nakamura
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keita Takahashi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiharu Nakae
- Department of Neurology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yohei Okada
- Department of Neurology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Gen Sobue
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Campagnolo M, Cacciavillani M, Briani C. Heterogeneous clinical and imaging findings and long-term prognosis in patients with neurolymphomatosis. Muscle Nerve 2020; 63:E24-E26. [PMID: 33346379 DOI: 10.1002/mus.27154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
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Vallat JM, Duchesne M, Corcia P, Richard L, Ghorab K, Magy L, Mathis S. The Wide Spectrum of Pathophysiologic Mechanisms of Paraproteinemic Neuropathy. Neurology 2020; 96:214-225. [PMID: 33277411 DOI: 10.1212/wnl.0000000000011324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022] Open
Abstract
Monoclonal gammopathy is encountered quite frequently in the general population. This type of hematologic abnormality may be mild, referred to as monoclonal gammopathy of undetermined significance or related to different types of hematologic malignancies. The association of a peripheral neuropathy with monoclonal gammopathy is also fairly common, and hemopathy may be discovered in an investigation of peripheral neuropathy. In such a situation, it is essential to determine the exact nature of the hematologic process in order not to miss a malignant disease and thus initiate the appropriate treatment (in conjunction with hematologists and oncologists). In this respect, nerve biopsy (discussed on a case-by-case basis) is of great value in the management of such patients. We therefore propose to present the objectives and main interests of nerve biopsy in this situation.
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Affiliation(s)
- Jean-Michel Vallat
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France.
| | - Mathilde Duchesne
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
| | - Philippe Corcia
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
| | - Laurence Richard
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
| | - Karima Ghorab
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
| | - Laurent Magy
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
| | - Stéphane Mathis
- From the Department of Neurology (J.-M.V., M.D., L.R., K.G., L.M.), National Reference Center for "Rare Peripheral Neuropathies," Dupuytren University Hospital (CHU Limoges), University of Limoges; Department of Pathology (M.D.), Limoges University Hospital (CHU Limoges), University of Limoges; Department of Neurology and ALS Reference Center (P.C.), Bretonneau University Hospital (CHU Tours), University of Tours; and Department of Neurology (S.M.), Nerve-Muscle Unit, 4 Pellegrin University Hospital (CHU Bordeaux), University of Bordeaux, France
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Doneddu PE, Cocito D, Manganelli F, Fazio R, Briani C, Filosto M, Benedetti L, Bianchi E, Jann S, Mazzeo A, Antonini G, Cosentino G, Marfia GA, Cortese A, Clerici AM, Carpo M, Schenone A, Siciliano G, Luigetti M, Lauria G, Rosso T, Cavaletti G, Beghi E, Liberatore G, Santoro L, Spina E, Peci E, Tronci S, Ruiz M, Cotti Piccinelli S, Verrengia EP, Gentile L, Leonardi L, Mataluni G, Piccolo L, Nobile-Orazio E. Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy. J Neurol Neurosurg Psychiatry 2020; 91:1092-1099. [PMID: 32868387 DOI: 10.1136/jnnp-2020-323615] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine the prevalence of different comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and their impact on outcome, treatment choice and response. METHODS Using a structured questionnaire, we collected information on comorbidities from 393 patients with CIDP fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society criteria included in the Italian CIDP database. RESULTS One or more comorbidities were reported by 294 patients (75%) and potentially influenced treatment choice in 192 (49%) leading to a less frequent use of corticosteroids. Response to treatment did not differ, however, from that in patients without comorbidities. Diabetes (14%), monoclonal gammopathy of undetermined significance (MGUS) (12%) and other immune disorders (16%) were significantly more frequent in patients with CIDP than expected in the general European population. Patients with diabetes had higher disability scores, worse quality of life and a less frequent treatment response compared with patients without diabetes. Patients with IgG-IgA or IgM MGUS had an older age at CIDP onset while patients with other immune disorders had a younger age at onset and were more frequently females. IgM MGUS was more frequent in patients with motor CIDP than in patients with typical CIDP. CONCLUSIONS Comorbidities are frequent in patients with CIDP and in almost 50% of them have an impact on treatment choice. Diabetes, MGUS and other immune diseases are more frequent in patients with CIDP than in the general population. Only diabetes seems, however, to have an impact on disease severity and treatment response possibly reflecting in some patients a coexisting diabetic neuropathy.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Dario Cocito
- Divisione di Riabilitazione Neuromotoria, Istituti Clinici Scientifici Maugeri - Presidio Sanitario Major, Torino, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Raffaella Fazio
- Department of Neurology, San Raffaele Hospital Institute of Experimental Neurology, Milano, Lombardia, Italy
| | - Chiara Briani
- Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Luana Benedetti
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, IRCCS-Istituto Mario Negri, Milano, Italy
| | - Stefano Jann
- Department of Neuroscience, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Giovanni Antonini
- Department of Neurology Mental Health and Sensory Organs (NESMOS), 'Sapienza' University of Rome, Sant' Andrea Hospital, Roma, Italy
| | - Giuseppe Cosentino
- Department of Neurology, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Andrea Cortese
- Department of Neurology, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Marinella Carpo
- Department of Neurology, ASST Bergamo Ovest-Ospedale Treviglio, Treviglio, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Giuseppe Lauria
- Unit of Neuroalgology, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy.,Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
| | - Tiziana Rosso
- UOC Neurologia-Castelfranco Veneto, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery and Experimental Neurology Unit, Universita degli Studi di Milano-Bicocca, Milano, Italy
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, IRCCS-Istituto Mario Negri, Milano, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Erdita Peci
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Stefano Tronci
- Department of Neurology, San Raffaele Hospital Institute of Experimental Neurology, Milano, Lombardia, Italy
| | - Marta Ruiz
- Department of Neuroscience, University of Padua, Padova, Italy
| | | | | | - Luca Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Luca Leonardi
- Department of Neurology Mental Health and Sensory Organs (NESMOS), 'Sapienza' University of Rome, Sant' Andrea Hospital, Roma, Italy
| | - Giorgia Mataluni
- Department of Systems Medicine, Univeristy of Roma Tor Vergata, Rome, Italy
| | - Laura Piccolo
- Department of Neurology, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy .,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milano, Lombardia, Italy
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Abstract
Peripheral neuropathies secondary to neurotoxicants are frequently considered but can be difficult to diagnose. Accurate diagnosis is important to avoid unnecessary testing, prevent further exposure, and initiate treatment when available. This article reviews key features of some of the more common or representative toxic neuropathies, including those caused by occupational and environmental exposure, medications, and chemotherapeutic agents.
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Affiliation(s)
- Michel Toledano
- Department of Neurology, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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47
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Keddie S, Nagendran A, Cox T, Bomsztyk J, Jaunmuktane Z, Brandner S, Manji H, Rees JH, Ramsay AD, Rossor A, D'Sa S, Reilly MM, Carr AS, Lunn MP. Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes. Muscle Nerve 2020; 62:617-625. [PMID: 32786031 DOI: 10.1002/mus.27045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/28/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022]
Abstract
This series characterises nine patients with neurohistopathologically proven peripheral nerve neurolymphomatosis. A search of the hospital neuropathology database from 2002 to 2019 identified biopsy proven cases. Clinical data, investigation modalities, treatments, and outcomes were collated. Median age at neuropathy onset was 47 y, the neuropathy commonly as the initial lymphoma disease manifestation. Most (8/9) presented with painful asymmetrical sensory disturbance, with additional cranial nerve involvement in three. Neurophysiology typically demonstrated multiple axonal mononeuropathies. Cerebrospinal fluid protein was often raised (6/8). Magnetic resonance imaging suggested peripheral nerve infiltration in 6/9 and positron emission tomography CT in 4/9. Bone marrow biopsy was abnormal in 6/8. Treatment involved systemic or intrathecal chemotherapy and radiotherapy. Median survival was 23 mo. Neurolymphomatosis is a rare but important cause of neuropathy, particularly in those lacking systemic evidence of lymphoma as correct aggressive treatment can prolong survival. Nerve biopsy is essential to classify lymphoma type and rule out alternatives.
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Affiliation(s)
- Stephen Keddie
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK.,Neuroimmunology and CSF Laboratory, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Arjuna Nagendran
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Tom Cox
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Joshua Bomsztyk
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital of Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital of Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
| | - Hadi Manji
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Jeremy H Rees
- Department of Neuro-Oncology, National Hospital of Neurology and Neurosurgery, London, UK
| | - Alan D Ramsay
- Haematopathology Unit, Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander Rossor
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Shirley D'Sa
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Aisling S Carr
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Michael P Lunn
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK.,Neuroimmunology and CSF Laboratory, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
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48
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Patil M, Muppidi V, Meegada S, Dowell KT, Bowers JD. Guillain-Barre Syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion as Paraneoplastic Syndromes in Splenic Marginal B-cell Non-Hodgkins Lymphoma: A Rare Presentation. Cureus 2020; 12:e10133. [PMID: 32879838 PMCID: PMC7456633 DOI: 10.7759/cureus.10133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Splenic marginal zone lymphoma (SMZL), a rare sub-type of non-Hodgkin lymphoma (NHL) presents with abdominal discomfort, lymphocytosis, cytopenias along with B symptoms including fatigue, night sweats, night fevers, weight loss. NHLs rarely present with paraneoplastic neurological syndromes like Guillain-Barre (GB) syndrome, myelopathy causing paraplegia, chorea, neuromyotonia, vasculitic neuropathy and dermatomyositis. Here, we present a 85-year old caucasian lady presenting with GB syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) who eventually got diagnosed with SMZL.
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Affiliation(s)
- Madhuri Patil
- Internal Medicine, CHRISTUS Good Shepherd Medical Center, Longview, USA
| | | | - Sreenath Meegada
- Internal Medicine, University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
| | - Keanan T Dowell
- Internal Medicine, CHRISTUS Good Shepherd Medical Center, Longview, USA
| | - Joe D Bowers
- Neurology, CHRISTUS Good Shepherd Medical Center, Longview, USA
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49
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El Dirani A, Hachem Z, Mohanna A, Zaylaa AJ. Traditional and Advanced Neuroimaging Contributions to the Diagnosis and Differential Diagnosis of Central Nervous System Lymphoma Patients Visiting a Comprehensive Medical Center. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The diagnosis of Central Nervous System Lymphoma, especially the Primary Central Nervous System Lymphoma is carried out based on brain imaging, thus avoiding an unnecessary extend of surgery. But the traditional imaging techniques, such as Computed Tomography and Magnetic Resonance Imaging, were not satisfactory.
Aims:
This study was conducted to characterize the spectrum of advanced Neuroimaging, such as the advanced Magnetic Resonance Imaging features in the Central Nervous System Lymphoma patients in a comprehensive medical center in Lebanon, and compare them to what has been described in the literature review.
Methods:
It is a retrospective exploratory study of the clinical data and imaging features for patients admitted to the emergency and radiology departments with ages above 10 years, and who were diagnosed histopathologically with intracranial lymphoma. This study may be the first to make a Radiological evaluation of Central Nervous System Lymphoma on the local population of patients over 9 years .
Results:
Results showed that the study of the Computed Tomography and Magnetic Resonance Imaging data of 10 immunocompetent patients with Central Nervous System Lymphoma concurs with the previously described patient populations, except for the gender parameter. Tumors were mostly presented in the fifth or Sixth decade and they could be solitary or multi-focal. Lesions were typically located Preprint submitted to The Open Neuroimaging Journal May 14, 2020 in the supratentorial compartment. On the brain Computed Tomography, the lesions were hyperdense, and in pre-contrast Magnetic Resonance images, the lesions appeared hypointense on T1 and hyperintense on T2-Weighted images, but hypointense with respect to the grey matter. The lesions were also surrounded with a mild to moderate edema as compared to other intracranial neoplasms, such as glioblastomas. Evaluation results showed that on post-contrast Magnetic Resonance images, the majority of lesions exhibited a homogeneous enhancement of 50%. Majority of the lesions also showed a less common heterogeneous ring-like enhancement of 40%, and revealed the uncommon absence of enhancement of 10%. Calcifications, hemorrhage, and necrosis were rare findings and were present in only one patient.
Conclusion:
As a future prospect, studying whether the advanced imaging techniques may provide not only non-invasive and morphological characteristics but also non-invasive biological characteristics and thus accurate diagnosis could be considered.
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50
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Briani C, Visentin A, Cerri F, Quattrini A. From pathogenesis to personalized treatments of neuropathies in hematological malignancies. J Peripher Nerv Syst 2020; 25:212-221. [PMID: 32686258 DOI: 10.1111/jns.12405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of several hematological diseases, the most common being monoclonal gammopathies (of undetermined significance or malignant) or lymphomas. The underlying pathogenic mechanisms are different and therapies aim at targeting the dangerous either B-cell or plasma cell clones. Recently, high-throughput technologies, and next-generation sequencing have increased our knowledge of hematological diseases pathogenesis by the identification of somatic mutation affecting pivotal signaling pathways. Accordingly, new target therapies are used that may also be borrowed for treatment of neuropathies in hematological diseases.
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Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federica Cerri
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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