Severe Paraneoplastic Parkinsonism: A Rare Cause Revealing Breast Cancer

Abida, Nabil; Tibar, Houyam; Boudhas, Adil; Oumerzouk, Jawad; Bourazza, Ahmed

doi:10.3988/jcn.2017.13.3.310

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…Positive immunofluorescence test results were also found after adding patient's anti-Hu on human myoenteric plexus commercial sections (image not shown). Notably, anti-NMDAR, GAD, CV2/CRMP5, and Ri antibodies, which have been previously reported to be associated with extrapyramidal syndromes (Tada et al, 2004 ; Pittock et al, 2006 ; Zandi et al, 2015 ; Mehta et al, 2016 ; Nabil et al, 2017 ), were absent.…”

Section: Case Presentationmentioning

confidence: 83%

“…As regards to parkinsonism, the paraneoplastic form is a well-known, despite uncommon, entity whose first reports were described almost 30 years ago, with the finding of degeneration of substantia nigra in a patient with infiltrating ductal breast carcinoma (Golbe et al, 1989 ). Since then, several different autoantibodies have been associated to the development of clinically heterogeneous extrapyramidal syndromes, presenting with dystonia, dyskinesia, corea or other motor symptoms (Tada et al, 2004 ; Pittock et al, 2006 ; Zandi et al, 2015 ; Dash et al, 2016 ; Mehta et al, 2016 ; Nabil et al, 2017 ). However, to our knowledge, no clear evidence of causal relation between anti-Hu antibodies and parkinsonism has been reported so far.…”

Section: Discussionmentioning

confidence: 99%

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MSA Mimic? Rare Occurrence of Anti-Hu Autonomic Failure and Thymoma in a Patient with Parkinsonism: Case Report and Literature Review

et al. 2018

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Thymoma is a tumor originating from thymic gland, frequently manifesting with paraneoplastic neurological disorders. Its association with paraneoplastic dysautonomia is relatively uncommon. Here, we describe the challenging case of a 71 year-old female who developed subacute autonomic failure with digestive pseudo-obstruction, dysphagia, urinary tract dysfunction and orthostatic hypotension complicating an underlying extrapyramidal syndrome that had started 3 months before hospital admission. Autonomic symptoms had 2-month course and acutely worsened just before and during hospitalization. Combination of severe dysautonomia and parkinsonism mimicked rapidly progressing multiple system atrophy. However, diagnostic exams showed thymic tumor with positive anti-Hu antibodies on both serum and cerebrospinal fluid. Complete response of dysautonomia to immunoglobulins followed by thymectomy confirmed the diagnosis of anti-Hu-related paraneoplastic neurological syndrome. With regards to extrapyramidal symptoms, despite previous descriptions of paraneoplastic parkinsonism caused by other antineuronal antibodies, in our case no relation between anti-Hu and parkinsonism could be identified. A literature review of published reports describing anti-Hu positivity in thymic neoplasms highlighted that a definite autonomic disease due to anti-Hu antibodies is extremely rare in patients with thymoma but without myasthenia gravis, with only one case published so far.

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Section: Case Presentationmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

MSA Mimic? Rare Occurrence of Anti-Hu Autonomic Failure and Thymoma in a Patient with Parkinsonism: Case Report and Literature Review

et al. 2018

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“…Nabil et al also reported a 63-year-old woman with severe paraneoplastic parkinsonism who initially presented with gradual worsening of resting tremor for six months, action tremor, difficulty with walking, and unsteadiness for three months [ 10 ]. The resting tremor was asymmetric in the beginning but later became bilateral.…”

Section: Discussionmentioning

confidence: 99%

DOPA-Responsive Tremor Associated With Gammopathy: A Case Report and Literature Review

Hamidi¹,

Kafaie²,

Gasimova³

2021

Cureus

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Tremors have been well-described in association with monoclonal gammopathy. We report a case of a patient with asymmetric hands tremor who responded well to levodopa-carbidopa treatment. Further workup showed an underlying gammopathy. To our knowledge, this is one of the rarest case reports of successful treatment of gammopathy-related tremors with levodopa-carbidopa. The patient was a 75-yearold male who presented to the neurology clinic for a one-year history of worsening tremors in bilateral upper extremities. A review of systems was only remarkable for mild numbness and tingling in his feet. His neurological examination was remarkable for asymmetric right more than left (R > L) resting and kinetic tremor in both upper extremities associated with mild rigidity and bradykinesia in right upper extremity and decreased bilateral ankle jerks. With the primary diagnosis of Parkinson's disease, he was started on levodopa-carbidopa and a neuropathy workup was requested. His follow-up visit after three months was remarkable for significant improvement of his tremors with carbidopa-levodopa. However, his blood work was consistent with a significant increase in lambda light chain levels and the presence of an M spike in serum protein electrophoresis. Based on the presentation and clinical workup, he was finally found to have both multiple myeloma and Waldenstrom's macroglobulinemia. Underlying malignancy was treated with chemotherapy and immunotherapy. Levodopa-carbidopa was discontinued after three months of chemotherapy and his tremor did not recur in one year of follow-up. Gammopathy is one of the well-known causes of tremors in the adult population. It can cause both resting and kinetic tremors in the upper extremities. It is supposed that peripheral neuropathy associated with gammopathy is the main underlying cause of tremors in these groups of patients. However, central causes are also suggested. In this case, we are led to conclude that our patient's tremor was centrally mediated since it responded well to dopamine replacement therapy. However, further study is needed to elucidate the role of dopamine depletion in the pathogenesis of tremors associated with gammopathies.

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“…Rapidly worsening PSP have been reported in association with breast carcinoma and positive anti-Ri antibodies. [ 3 ] This patient had no functional imaging, did not respond to tumerectomy, immunotherapy, or levodopa, ultimately succumbing to her illness 8 months later. [ 3 ] B-cell lymphoma[ 4 ] and bronchial carcinoma[ 5 ] are the malignancies other than breast carcinoma though neither had any paraneoplastic antibody.…”

mentioning

confidence: 99%

“…[ 3 ] This patient had no functional imaging, did not respond to tumerectomy, immunotherapy, or levodopa, ultimately succumbing to her illness 8 months later. [ 3 ] B-cell lymphoma[ 4 ] and bronchial carcinoma[ 5 ] are the malignancies other than breast carcinoma though neither had any paraneoplastic antibody. Anti-Ri antibodies have been described in 2 patients with parkinsonism and breast cancer among 28 patients with paraneoplastic syndromes[ 6 ] making it the most commonly detected antibody in such a scenario and it has been associated with more severe neurological impairment.…”

mentioning

confidence: 99%

Redeemable “Progressive Supranuclear Palsy” Like Paraneoplastic Presentation in Carcinoma Breast

Cherian¹,

Paramasivan²,

Prabhakaran³

et al. 2021

Annals of Indian Academy of Neurology

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Severe Paraneoplastic Parkinsonism: A Rare Cause Revealing Breast Cancer

Cited by 5 publications

References 6 publications

MSA Mimic? Rare Occurrence of Anti-Hu Autonomic Failure and Thymoma in a Patient with Parkinsonism: Case Report and Literature Review

MSA Mimic? Rare Occurrence of Anti-Hu Autonomic Failure and Thymoma in a Patient with Parkinsonism: Case Report and Literature Review

DOPA-Responsive Tremor Associated With Gammopathy: A Case Report and Literature Review

Redeemable “Progressive Supranuclear Palsy” Like Paraneoplastic Presentation in Carcinoma Breast

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