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Anti-Ta-associated paraneoplastic encephalitis with occult testicular intratubular germ-cell neoplasia
  1. Harald Prüss1,
  2. Raymond Voltz2,
  3. Bernd Flath3,
  4. Birgit Rudolph4,
  5. Randolf Klingebiel5,
  6. Rolf Zschenderlein6,
  7. Konstantin Prass6
  1. 1Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
  2. 2Department of Palliative Medicine, University of Cologne, Cologne, Germany
  3. 3Department of Oncology, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
  4. 4Department of Pathology, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
  5. 5Department of Neuroradiology, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
  6. 6Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
  1. Correspondence to:
 Dr H Prüss
 Department of Neurology, Charité, University Medicine Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany; harald.pruess{at}charite.de

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Anti-Ta-associated encephalitis is a paraneoplastic inflammatory brain disorder with immune-mediated neurological symptoms. The well-characterised onconeuronal antibody, anti-Ta, reacts with the paraneoplastic protein PNMA2 (former antibody name: anti-Ma2). 1 Neurological symptoms often include abnormalities in eye movement, short-term memory loss, seizures, irritability, personality change or confusion.2,3 The symptoms tend to precede tumour diagnosis and are often more debilitating than the malignancy itself.2 The first study of anti-Ta-related paraneoplastic encephalitis reported 10 young men with testicular cancer.3 Other tumours occur in females4 and approximately 30 cases have been reported.2,5 Several tumours express the protein that, in healthy adults, is restricted to brain and testicular germ cells.3 In contrast to other paraneoplastic syndromes, a remarkable number of patients show neurological improvement if the underlying tumour allows complete surgical resection.2 We report a patient’s history of anti-Ta-associated neurological syndrome with atypical parkinsonism and massive rigidity due to occult testicular cancer.

Case report

In 2001, a 66-year-old man suddenly developed disorientation, restlessness, psychomotor agitation and fever. A bradykinetic syndrome with rigidity was noted. Verbal output was reduced and the patient responded only in short sentences. Head CT and lumbar puncture examinations were normal, and EEG demonstrated a right temporal epileptic focus.

After 2 weeks, the patient was admitted to the Department of Neurology, Charité, University Medicine Berlin, Berlin, Germany, with further neurological deterioration. He was drowsy, with markedly reduced verbal output, and only occasionally followed simple …

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