Cerebrospinal fluid study in paraneoplastic syndromes

Psimaras, Dimitri; Rossi, Carlotta

doi:10.1136/jnnp.2008.159483

Cited by 120 publications

(87 citation statements)

References 26 publications

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“…Examinations, as CSF analysis, and MRI, can help in the diagnosis. In paraneoplastic diseases, CSF examination is frequently abnormal, showing an inflammatory pattern in up to 93% of cases [34]. Our results are not completely consistent with this observation, because only 78% of our cases showed pathological CSF.…”

Section: Discussioncontrasting

confidence: 64%

Chorea and related movement disorders of paraneoplastic origin: the PNS EuroNetwork experience

et al. 2011

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Chorea and other movement disorders are rarely described as paraneoplastic. The aim of this study was to describe 13 patients with paraneoplastic chorea and dystonia collected by the members of the paraneoplastic neurological syndrome (PNS) EuroNetwork and to review 29 cases from the literature. We analyzed neurological symptoms, severity of the neurological syndrome, delay in neurological diagnosis, associated cancer, oncological and neurological treatments received, and outcome. Eleven (1.2%) out of 913 patients with PNS were identified in the EuroNetwork register. Two more patients not included in the register were added. The overall population consisted of 13 patients with a median age of 75 years (range 49-82 years). In most patients, the movement disorder was classical choreoathetosis with symmetric involvement of the trunk, neck, and limbs. A minority of patients presented unilateral chorea, dystonia, and orobuccal dyskinesia. Associated symptoms, as polyneuropathy, encephalitis, psychiatric disturbances, or visual defects, were often present. The movement disorder usually had a subacute course. The most frequently associated cancer was small cell lung cancer (SCLC). Lymphoma, bowel, or kidney cancers were also reported. CV2/CRMP5 was the most frequently associated antibody, followed by Hu. Hyperintense lesions of the basal ganglia on T2-weighted images were seldom observed. Response to cancer therapy was observed in a minority of patients, but survival was short (17 months). As in other neurological diseases, movement disorders should also be suspected as paraneoplastic when they develop subacutely in older patients (usually over 50) and often in the presence of other ancillary neurological symptoms.

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Section: Discussioncontrasting

confidence: 64%

Chorea and related movement disorders of paraneoplastic origin: the PNS EuroNetwork experience

et al. 2011

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“…It may be particularly helpful with infectious, autoimmune, and neoplastic disorders (figure 1). Lymphocytic pleocytosis, elevated protein level, high immunoglobulin G index, or oligoclonal bands are often present in AEs, 6 particularly those of paraneoplastic etiology, 24 although they are not specific and might occur in patients with CJD, neuroinfections generating a strong immune response (e.g., subacute sclerosing panencephalitis), or neoplasias. In CJD, basic CSF analysis is typically normal, but in our cohort 50% of cases show mildly increased protein levels (usually 50-100 mg/dL).…”

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confidence: 99%

Diagnosis and treatment of rapidly progressive dementias

2012

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SummaryRapidly progressive dementias are conditions that typically cause dementia over weeks or months. They are a particular challenge to neurologists as the differential diagnosis often is different from the more typical, slowly progressive dementias. Early and accurate diagnosis is essential, as many of the etiologies are treatable. The information in this review is in part based on experience through our rapidly progressive dementia program at the University of California San Francisco, Memory and Aging Center. As treatment of a rapidly progressive dementia is entirely dependent on the diagnosis, we present a comprehensive, structured, but pragmatic approach to diagnosis, including key clinical, laboratory, and radiologic features. For the 2 most common causes of rapid dementia, treatment algorithms for the autoimmune encephalopathies and symptomatic management for the neurodegenerative causes are discussed.A lthough no formal definition exists for what constitutes a rapidly progressive dementia (RPD), generally we use the term when dementia occurs in less than 1-2 years from illness onset, but more commonly over weeks to months.1 Because these conditions are relatively uncommon, the appropriate diagnostic workup and treatments often are unfamiliar to many neurologists. Accurate, thorough, and prompt diagnosis is important as many RPDs are treatable, and even curable. In this article, we present a practical, systematic approach for RPD diagnosis as well as treatment algorithms for the management of immunotherapy-responsive and other dementias. Etiology of RPDsThe breakdown of etiologies of RPDs varies among dementia centers. At our center (University of California, San Francisco, Memory and Aging Center), the diagnostic breakdown of RPDs *These authors contributed equally to this work.

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“…Die Liquoruntersuchung ist sensitiver, jedoch ebenso unspezifi sch. Hier helfen neuere Daten, die Häufi gkeit und Art von Liquorauff älligkeiten bei paraneoplastischen Syndromen besser einzuschätzen [ 93 ] . Der Liquor ist meist entzündlich verändert, häufi g bestehen geringe lymphozytäre Pleozytosen und/oder oligoklonale Banden, gelegentlich auch nur Schrankenstörun-gen. Bei 90 % der paraneoplastischen Erkrankungen ist zumindest einer dieser 3 Parameter auff ällig.…”

Section: Neues Zur Diagnostikunclassified

“…Die lymphozytäre Pleozytose nimmt mit zunehmender Dauer der Erkrankung ab (50 % während der ersten 3 Monate, 30 % danach), während die Inzidenz der Schrankenstörung zunimmt. Bei 7 % ist der Liquor allerdings komplett unauff ällig [ 93 ] . Die weiteren Untersuchungen hängen vom betroff enen System ab.…”

Section: Neues Zur Diagnostikunclassified

Neues bei paraneoplastischen Syndromen in der Neurologie

2012

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Zusammenfassung In nur wenigen Jahren hat sich das Spektrum und damit das Wissen um paraneoplastische Syndrome in der Neurologie deutlich erweitert. Insbesondere hat die Beschreibung neuer fakultativ paraneoplastischer Subgruppen von Enzephalitiden mit gutem Ansprechen auf immunmodulatorische Therapien das klinische und wissenschaftliche Interesse verst?rkt. Das Erkennen dieser Subgruppen mittels neuartiger Autoantik?rper hat unmittelbare therapeutische Konsequenzen. Die fundierte Kenntnis paraneoplastischer Syndrome in der Neurologie ist daher ?u?erst wichtig f?r den Kliniker. Neue wissenschaftliche Erkenntnisse beleuchten interessante Aspekte der Pathophysiologie paraneoplastischer Prozesse, ihrer m?glichen Reversibilit?t und Initiierung. Neue Registerdaten helfen die Epidemiologie paraneoplastischer neurologischer Syndrome besser einzusch?tzen. Der zunehmende Einsatz von ?Biologika? in der Neurologie er?ffnet zuk?nftig neue Therapiechancen. Allerdings f?hrt die mittlerweile entstandene F?lle an neuen Syndromen und Autoantik?rpern auch vielfach zu Verwirrung und Unsicherheit. Diese ?bersichtsarbeit fasst daher neue und wichtige ?ltere Aspekte paraneoplastischer neurologischer Syndrome, ihrer Klassifikation, Pathophysiologie und Behandlung zusammen.

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Cerebrospinal fluid study in paraneoplastic syndromes

Abstract: CSF inflammation is a common finding in PNS patients and can be a helpful tool for diagnosis, especially if this analysis is done within 3 months after neurological onset.

Cited by 120 publications

References 26 publications

Chorea and related movement disorders of paraneoplastic origin: the PNS EuroNetwork experience

Chorea and related movement disorders of paraneoplastic origin: the PNS EuroNetwork experience

Diagnosis and treatment of rapidly progressive dementias

Neues bei paraneoplastischen Syndromen in der Neurologie

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