A case of acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody

Kuzume, Daisuke; Sajima, Kazuaki; Kon-No, Yuko; Kaneko, Keiko; Yamasaki, Masahiro

doi:10.5692/clinicalneurol.cn-000683

Cited by 3 publications

(6 citation statements)

References 9 publications

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“…and Kumada et al . reported Gal‐C‐positive cases with brainstem lesions 14,15 . The brainstem might be more likely to be affected in some anti‐Gal‐Cal cases with antibody‐related neuronal diseases.…”

Section: Discussionmentioning

confidence: 98%

“…also reported an 82‐year‐old man with brainstem and cerebellar ADEM lesions, whose serum contained anti‐Gal‐C antibodies. Thus, a few cases of anti‐Gal‐C antibody‐positive brain lesions have been reported 14 . Further accumulation of similar cases is necessary to understand the pathophysiology of anti‐Gal‐C associated CNS disorders.…”

Section: Discussionmentioning

confidence: 99%

“…13 However, Kuzume et al and Kumada et al reported Gal-C-positive cases with brainstem lesions. 14,15 The brainstem might be more likely to be affected in some anti-Gal-Cal cases with antibody-related neuronal diseases. Also, Samukawa et al reported that ADEM with positive anti-Gal-C antibodies tends to have a poor response to steroid, which is consistent with the clinical course of the present patient.…”

Section: Discussionmentioning

confidence: 99%

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Immunotherapy‐responsive brainstem lesion accompanied with anti‐galactocerebroside antibody

Shiraishi

2021

Clinical & Exp Neuroim

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Background: Brainstem lesions are a diagnostic challenge and clinicians have to differentiate between many diseases including acute disseminated encephalomyelitis, multiple sclerosis (MS), Bickerstaff brainstem encephalitis (BBE) and brain tumors.The anti-galactocerebroside (Gal-C) antibody is an anti-glycolipid antibody that is often detected in autoimmune peripheral neuropathy. However, anti-Gal-C antibody is rarely detected in autoimmune central nervous system diseases. Here, we report the case of an anti-Gal-C antibody-positive patient who had a brainstem lesion that mimicked MS and responded to immunotherapy. Case presentation:We report a 32-year-old woman who presented with subacute numbness of the right lower extremities and hemiataxia. Her cerebrospinal fluid examination showed an elevated myelin basic protein level and an oligoclonal band.How to cite this article: Shiraishi W. Immunotherapyresponsive brainstem lesion accompanied with antigalactocerebroside antibody.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Immunotherapy‐responsive brainstem lesion accompanied with anti‐galactocerebroside antibody

Shiraishi

2021

Clinical & Exp Neuroim

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Section: Discussionmentioning

confidence: 98%

“…Although several previous reports have documented respiratory failure in patients with ADEM exhibiting unilateral medullary lesions, no reports have documented the occurrence of concurrent bilateral medullary lesions in such patients. [1][2][3][4][5] Francis et al 5 reported that two patients who had developed ADEM following M. pneumoniae infection exhibited no improvement, although these patients underwent artificial respiration only and were not treated using anti-inflammatory and immunosuppressive drugs. Our patient experienced severe symptoms including respiratory arrest, impaired consciousness, and tetraplegia; however, his clinical symptoms improved remarkably following immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection complicated by respiratory arrest due to concurrent bilateral lateral medullary lesions: A case report

Fukuoka

Nakazato

Kawasaki

et al. 2018

Neurology & Clinical Neurosc

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Reports on concurrent bilateral lateral medullary lesions in patients with neurological disorders are lacking. Herein, we discuss the case of a 40‐year‐old man who developed acute disseminated encephalomyelitis due to Mycoplasma pneumoniae infection. Brain magnetic resonance imaging revealed high signal intensities and demyelination in the concurrent bilateral lateral medulla and cervical spinal cord. Clinical features included respiratory arrest and psychiatric symptoms, although his symptoms improved several months following the initiation of artificial respiration and repeated steroid pulse therapy. Such findings emphasize the need to carefully monitor patients with acute disseminated encephalomyelitis exhibiting concurrent bilateral medullary lesions due to the risk of sudden respiratory arrest.

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Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre

et al. 2019

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ObjectiveWe set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).MethodsWe reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have ‘true’ ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described.ResultsThe presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. ‘True’ ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with ‘pseudo’ ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001).ConclusionsElevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.

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A case of acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody

Cited by 3 publications

References 9 publications

Immunotherapy‐responsive brainstem lesion accompanied with anti‐galactocerebroside antibody

Immunotherapy‐responsive brainstem lesion accompanied with anti‐galactocerebroside antibody

Acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection complicated by respiratory arrest due to concurrent bilateral lateral medullary lesions: A case report

Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre

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