A case of possible paraneoplastic neurological syndrome presenting as multiple cranial nerve palsies associated with gallbladder cancer

Kaido, Misako; Yuasa, Yoshihito; Yamamoto, Tameyoshi; Munakata, Satoru; Tagawa, Naohiro; Tanaka, Keiko

doi:10.5692/clinicalneurol.cn-000906

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…17 Symptoms may be more extensive when there is involvement of multiple cranial nerves, as seen in 1 report of paraneoplastic neuropathy of the third, sixth, and seventh cranial nerves in a patient with gallbladder carcinoma. 18 Anti-Hu/ANNA-1 and the newly described antibodies to Kelchlike protein-11 associated with seminoma are especially associated with paraneoplastic cranial neuropathy.…”

Section: Head: Cranial Neuropathymentioning

confidence: 99%

Imaging Review of Paraneoplastic Neurologic Syndromes

Madhavan¹,

Carr²,

Morris³

et al. 2020

AJNR Am J Neuroradiol

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Paraneoplastic syndromes are systemic reactions to neoplasms mediated by immunologic or hormonal mechanisms. The most well-recognized paraneoplastic neurologic syndrome, both clinically and on imaging, is limbic encephalitis. However, numerous additional clinically described syndromes affect the brain, spinal cord, and peripheral nerves. Many of these syndromes can have imaging findings that, though less well described, are important in making the correct diagnosis. Moreover, imaging in these syndromes frequently mimics more common pathology, which can be a diagnostic challenge for radiologists. Our goal is to review the imaging findings of paraneoplastic neurologic syndromes, including less well-known entities and atypical presentations of common entities. Specifically, we discuss limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic brain stem encephalitis, cranial neuropathy, myelitis, and polyneuropathy. We also demonstrate common diagnostic pitfalls that can be encountered when imaging these patients. ABBREVIATIONS: ANNA ¼ antineuronal nuclear autoantibody; PNS ¼ paraneoplastic neurologic syndrome; PCD ¼ paraneoplastic cerebellar degeneration P araneoplastic syndromes (PNSs) result from systemic reactions to neoplasms, often mediated by immunologic or hormonal mechanisms. PNSs include limbic encephalitis, encephalomyelitis, paraneoplastic cerebellar degeneration (PCD), brain stem encephalitis, polyneuropathy, stiff-person syndrome, retinopathy, myasthenia gravis, Lambert-Eaton myasthenic syndrome, and enteric nervous system dysfunction (Fig 1). These syndromes are often associated with serum or CSF positivity of onconeuronal or neuronal cell surface antibodies. Onconeuronal antibodies are more directly associated with underlying neoplasms and cause neuronal dysfunction by recruitment of cytotoxic T cells. In contrast, neuronal cell surface antibodies are less commonly associated with an underlying neoplasm and mediate pathology by directly binding to neurons. PNSs can occur in the presence or absence of paraneoplastic antibodies and are ultimately a clinical diagnosis. Conversely, antibody-mediated neurologic syndromes can occur in the absence of malignancy, though these are separately classified. 1 PARANEOPLASTIC NEUROLOGIC SYNDROMES BY ANATOMIC LOCATION Brain: Limbic Encephalitis Limbic encephalitis refers to inflammatory changes involving the limbic system, which includes the hippocampus, amygdala, hypothalamus, and cingulate cortex. Symptoms include mood and

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Section: Head: Cranial Neuropathymentioning

confidence: 99%

Imaging Review of Paraneoplastic Neurologic Syndromes

Madhavan¹,

Carr²,

Morris³

et al. 2020

AJNR Am J Neuroradiol

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“…While rarely associated with Hodgkin's and non-Hodgkin's lymphoma, these often develop into lymphoma during the end stages of the disease ( 6 ). However, early detection of asymptomatic gall bladder cancer in a patient with multiple cranial palsies during possible paraneoplastic neurological syndrome has also been reported ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Isolated oculomotor nerve palsy as a manifestation of diffuse large B cell lymphoma: A case report

et al. 2020

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An isolated third nerve palsy presenting as the primary manifestation of a lymphoma is rare, with only few cases having been described. The present study reports an unusual case of a healthy 67-year old male diagnosed with isolated right oculomotor nerve palsy (ONP), who was found to have an underlying B cell lymphoma. The patient's medical records were accessed upon consent. A thorough physical examination, including stroke and infections work-ups were performed. A chest computerized tomography (CT), brain magnetic resonance imaging and positron emission tomography (PET) scans and a mediastinal tissue biopsy, were performed as part of systematic diagnostic evaluations. The current report suggests that a PET fluorodeoxyglucose study or a CT scan of the chest, abdomen and pelvis (with contrast) may help in the early diagnosis of a cancer responsible for ONP, particularly if brain vessel imaging does not show a posterior cerebral artery aneurysm as a cause for the defect.

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“…Literature has described a case of a multiple cranial palsies associated with gallbladder cancer [8].…”

Section: Discussionmentioning

confidence: 99%

Unusual third cranial nerve palsy presentation with unexpected distant departure point

Sousa¹,

Barata²,

Teixeira³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We present the clinical case of a 72-year-old Caucasian male with ophthalmological history of right eye amblyopia caused by an untreated esotropia, who went to the emergency room presenting holocranial headache, ptosis and temporary diplopia. The pupils were symmetric with a present but slowed down right direct reflex, and a doubtful Marcus Gunn pupil. The patient was orthotropic. Ocular motility examination showed a limitation in adduction, elevation and depression of the right eye. The patient had a computed tomography (CT) of the brain and orbits, a analytical study, a CT angiography, a brain magnetic resonance, a lumbar puncture, a CT scan of the neck, chest, abdomen and pelvis, a flexible cystoscopy, and a transurethral resection. Once made, the histology of the biopsies of TUR revealed fragments of a infiltrative urothelial carcinoma of high grade. IJCRI publishes Conclusion:The oculomotor nerve palsy may be the first manifestation of a serious systemic disease and appear in an atypical form in a patient with a previous esotropia. Careful assessment and investigation should be taken.

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A case of possible paraneoplastic neurological syndrome presenting as multiple cranial nerve palsies associated with gallbladder cancer

Cited by 8 publications

References 18 publications

Imaging Review of Paraneoplastic Neurologic Syndromes

Imaging Review of Paraneoplastic Neurologic Syndromes

Isolated oculomotor nerve palsy as a manifestation of diffuse large B cell lymphoma: A case report

Unusual third cranial nerve palsy presentation with unexpected distant departure point

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