Abstract
Introduction
Paraneoplastic neurological disorders are a well recognized complication of malignancy.
Methods
A case report to expand the currently described clinical manifestations of type 1 antineuronal antibody (ANNA-1)-associated paraneoplastic encephalomyelitis to include coma.
Results
We present an unusual case of fluctuating coma and rapid fulminant progression to acute respiratory failure from central alveolar hypoventilation caused by ANNA-1 paraneoplastic encephalomyelitis associated with small-cell lung carcinoma. Paraneoplastic infiltration of the brainstem and cerebellum, including respiratory and arousal centers, was documented on autopsy.
Conclusions
Paraneoplastic encephalomyelitis should be considered as a possible cause of coma and central alveolar hypoventilation.
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References
Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003;349(16):1543–1554.
Pittock SJ, Kryzer TJ, Lennon VA. Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol 2004;56(5):715–719.
Chan KH, Vernino S, Lennon VA. ANNA-3 anti-neuronal nuclear antibody: marker of lung cancer-related autoimmunity. Ann Neurol 2001;50(3):301–311.
Ball JA, Warner T, Reid P, Howard RS, Gregson NA, Rossor MN. Central alveolar hypoventilation associated with paraneoplastic brain-stem encephalitis and anti-Hu antibodies. J Neurol 1994;241(9):561–516.
Crino PB, Galetta SL, Sater RA, et al. Clinicopathologic study of paraneoplastic brainstem encephalitis and ophthalmoparesis. J Neuroophthalmol 1996;16(1):44–48.
Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology 1998:50(3):652–657.
Kaplan AM, Itabashi HH. Encephalitis associated with carcinoma. Central hypoventilation syndrome and cytoplasmic inclusion bodies. J Neurol Neurosurg Psychiatry 1974;37(10):1166–1176.
Dalmau J, Graus F, Rosenblum MK, Posner Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy JB. A clinical study of 71 patients. Medicine (Baltimore) 1992; 71(2):59–72.
Pittock SJ, Lucchinetti CF, Lennon VA. Anti-neuronal nuclear autoantibody type 2: paraneoplastic accompaniments. Ann Neurol 2003;53(5):580–587.
Rosenfeld MR, Eichen JG, Wade DF, Posner JB, Dalmau J. Molecular and clinical diversity in paraneoplastic immunity to Ma proteins. Ann Neurol 2001;50(3):339–348.
Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms immunological findings and tumour association in 50 patients. Brain 2001;123(Pt 7):1481–1494.
Dalmau J, Graus F, Villarejo A, et al. Clinical analysis of anti-Ma2-associated encephalitis. Brain 2004;127(Pt 8):1831–1844.
Nokura K, Yamamoto H, Okawara Y, Koga H, Osawa H, Sakai K. Reversible limbic encephalitis caused by ovarian teratoma. Acta Neurol Scand 1997;95(6):367–373.
Norris S, Rajendiran S, Sheahan K, et al. Noncirrhotic hepatoma presenting with paraneoplastic neurologic manifestations: two cases. Am J Gastroenterol 1997;92(10):1923–1926.
Graus F, Keime-Guibert F, Rene R, et al. Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients. Brain 2001; 124(Pt 6):1138–1148.
Sillevis Smitt P, Grefkens J, de Leeuw B, et al. Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol 2002;249(6):745–753.
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Lee, K.S., Higgins, M.J., Patel, B.M. et al. Paraneoplastic coma and acquired central alveolar hypoventilation as a manifestation of brainstem encephalitis in a patient with ANNA-1 antibody and small-cell lung cancer. Neurocrit Care 4, 137–139 (2006). https://doi.org/10.1385/NCC:4:2:137
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DOI: https://doi.org/10.1385/NCC:4:2:137