FDG PET Unveils the Course of Paraneoplastic Cerebellar Degeneration

Massa, Federico; Filippi, Laura; Benedetti, Luana; Morbelli, Silvia; Nobili, Flavio

doi:10.1097/rlu.0000000000003547

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…At an early disease stage, structural brain imaging is commonly normal 1. The neoplasms most commonly involved are small cell lung cancer, gynecological (including carcinoma of the fallopian tube) and breast tumors, and Hodgkin lymphomas,[1][2][3][4][5] but it is also described in, for example, carcinoma of the tonsil, gastric adenocarcinoma, and extragonadal germ cell tumors [6][7][8]. An acute cerebellar syndrome is one of the most common neurological paraneoplastic syndromes and is most likely immune mediated 1.…”

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confidence: 99%

Paraneoplastic Cerebellar Syndrome Presented as Cerebellar Hypermetabolism in a Patient With Occult Breast Carcinoma

et al. 2022

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A 47-year-old woman presented with an acute cerebellar syndrome. Neither cerebellar atrophy nor an infarction or tumor was shown on MRI. A diagnostic CT demonstrated enlarged axillary lymph nodes, but no primary tumor. Puncture of these nodes showed non-small cell carcinoma. 18 F-FDG PET/CT imaging was performed and suggested an occult breast carcinoma, which was confirmed by pathological examination. It also showed cerebellar hypermetabolism, consistent with a PCS (paraneoplastic cerebellar syndrome). This case shows that 18 F-FDG PET imaging may be of value in patients in which a PCS is considered clinically, particularly in patients suspicious for an occult malignancy.

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Paraneoplastic Cerebellar Syndrome Presented as Cerebellar Hypermetabolism in a Patient With Occult Breast Carcinoma

et al. 2022

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“…[ 18 F]-FDG-PET was more sensitive than MRI in matching clinical courses, even at the level of cognitive and psychiatric symptoms, thus confirming to yield information usable as consistent as biomarkers of disease severity, recovery after treatment, and functional outcome [ 16 , 17 ].…”

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confidence: 99%

Intravenous immunoglobulin bridging to rituximab in NMDAR encephalitis patients non-responders to first-line treatments

et al. 2022

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Background The immunotherapy strategy for autoimmune encephalitis is based on several types and schedules of both first- and second-line drugs. Failing to respond to the latter prompts the use of non-conventional rescue therapies, with higher risks of severe adverse effects. We report on a protocol that entails the use of intravenous immunoglobulin cycles to bridge the 4-month period that the second-line drug rituximab needs to exert its full therapeutic effects. Methods Three patients with NMDAR encephalitis who were non-responders to first-line treatments entered the study. The protocol consisted of six monthly cycles of intravenous immunoglobulins (IVIG, 0.4 mg/kg/die for 5 days), starting 1 month after the last rituximab infusion (1000 mg at days 0 and 15). Brain MRI and [18F]-FDG-PET were performed at onset and at six and 18 months after onset. Results In the three patients, substantial improvements of disability or complete recovery were achieved, without modifications over the 30-to-50-month follow-up. No adverse events nor laboratory test abnormalities were recorded. Imaging findings paralleled the favorable disease courses. Brain [18F]-FDG-PET was more sensitive than MRI in detecting abnormalities. Discussion Our observations suggest that the herein-described protocol might be used in patients with NMDAR encephalitis at risk for poor prognosis in the mid-term when they need to shift to rituximab. [18F]-FDG-PET confirmed to be a sensitive tool to detect the minimal brain lesions that can underlie isolated cognitive and psychiatric symptoms.

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“…Studies with larger series are needed to examine FDG uptake patterns of causative autoantibodies. In characterizing these patterns, voxel-based analysis beyond visual reading of PET images can prove beneficial and improve diagnostic accuracy 14,17 . In sum, given the variable clinical presentation, imaging results, and autoantibodies underlying limbic encephalitis, FDG PET can be a sensitive adjunct.…”

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confidence: 99%

“…In characterizing these patterns, voxel-based analysis beyond visual reading of PET images can prove beneficial and improve diagnostic accuracy. 14,17 In sum, given the variable clinical presentation, imaging results, and autoantibodies underlying limbic encephalitis, FDG PET can be a sensitive adjunct. PET can detect early metabolic changes and confirm suspicions of limbic encephalitis.…”

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18F-FDG PET and MRI Evaluation of Paraneoplastic Limbic Encephalitis

2023

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Autoimmune limbic encephalitis (paraneoplastic or nonparaneoplastic) is a rare condition involving autoantibodies against intracellular or cell-surface proteins of neurons. Patients typically present with acute and progressive neuropsychiatric symptoms. Although the criterion standard for diagnosis remains detection of autoantibodies in cerebrospinal fluid, there are characteristic imaging features that can aid in diagnosis, notably abnormalities in the bilateral medial temporal lobes on imaging, particularly with nuclear imaging. Here, we present 18F-FDG PET findings of paraneoplastic limbic encephalitis in a 65-year-old man.

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FDG PET Unveils the Course of Paraneoplastic Cerebellar Degeneration

Cited by 3 publications

References 10 publications

Paraneoplastic Cerebellar Syndrome Presented as Cerebellar Hypermetabolism in a Patient With Occult Breast Carcinoma

Paraneoplastic Cerebellar Syndrome Presented as Cerebellar Hypermetabolism in a Patient With Occult Breast Carcinoma

Intravenous immunoglobulin bridging to rituximab in NMDAR encephalitis patients non-responders to first-line treatments

18F-FDG PET and MRI Evaluation of Paraneoplastic Limbic Encephalitis

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