Upbeat nystagmus in anti-Ma2 encephalitis

Garcia-Reitboeck, Pablo; Thompson, G M; Johns, Paul; Wahab, Yasir Al; Omer, Salah; Griffin, Colette

doi:10.1136/practneurol-2013-000524

Cited by 20 publications

(9 citation statements)

References 8 publications

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“…[5][6][7] Anti-Ma2 antibody encephalitis is very rare and is characterized by neuro-ophthalmologic abnormalities, ataxia, seizure, dysarthria, and decreased mentality. [1][2][3][4] However, unlike previous reports, our patient showed dominant psychiatric symptoms of memory impairment, decreased speech, depressed mood, anxiety, disorganized language, and aggressiveness, but there was no clear evidence of seizure, ataxia, neuro-ophthalmologic abnormalities, or systemic tumor. Therefore, although the patient manifested unusual symptoms, he did not visit the hospital for 2 months because his family assumed that he was experiencing psychiatric problems (e.g., depression, stress, and anxiety).…”

Section: Discussioncontrasting

confidence: 52%

“…[1][2][3][4] The literature includes a few case reports in which anti-Ma2 antibody encephalitis involved the brainstem and limbic system; these patients showed neuropsychiatric manifestations, including neuro-ophthalmologic abnormalities, dizziness, headache, ataxia, seizure, and drowsiness. [1][2][3][4] Given the rarity of the condition and the need to test levels of specific antibodies, diagnosing anti-Ma2 antibody encephalitis is a very difficult and challenging process. Therefore, a physician's knowledge of and experience with autoimmune encephalitis are important for proper diagnosis and treatment.…”

mentioning

confidence: 99%

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Anti-Ma2 Antibody Encephalitis Manifesting as Cognitive Impairment and Psychosis

Park

Bae

Jeong

et al. 2015

JNP

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Section: Discussioncontrasting

confidence: 52%

mentioning

confidence: 99%

Anti-Ma2 Antibody Encephalitis Manifesting as Cognitive Impairment and Psychosis

Park

Bae

Jeong

et al. 2015

JNP

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“…In this patient screening for tumor was negative. Garcia‐Reitboeck reported a 63 years old lady who presented with ataxia, and upbeat and lid nystagmus . There was no tumor identified at autopsy, but the anti‐Ma2 antibodies were detected in her serum.…”

Section: Search Resultsmentioning

confidence: 99%

Movement disorders associated with neuronal antibodies

Dash

Pandey

2018

Acta Neurol Scand

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Movement disorders are one of the common clinical features of neurological disease associated with neuronal antibodies which is a group of potentially reversible disorder. They can present with hypokinetic or hyperkinetic types of involuntary movements and may have other associated neurological symptoms. The spectrum of abnormal movements associated with neuronal antibodies is widening. Some specific phenomenology of movement disorders are likely to give clue about the type of antibody, for instance, presence of paroxysmal dystonia (facio-brachial dystonic seizures) are a pointer toward presence of LGI-1 antibodies, and orofacial lingual dyskinesia is associated with NMDAR associated encephalitis. The presence of specific type of movement disorder allows high suspicion of testing of certain specific type of antibodies. In this review, we have discussed the various antibodies and the spectrum of movement disorder associated with them, highlighting if any distinct movement disorder allows the clinician to suspect type of antibody in a certain clinical context. We have also reviewed the treatment of the movement disorder associated with the neuronal antibodies. Physicians should have high index of suspicion of these disorders, as early institution of treatment options can lead to better outcome.

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“…Ko and colleagues [6] state that can also occur in paraneoplastic cerebellar degeneration, though reports of this are rare; it has been described in the presence of anti-Hu antibodies associated with pancreatic carcinoma [7] and anti-Ma2 antibodies [8] in which the primary neoplasm was not identified.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Upbeat Nystagmus in Renal Cell Carcinoma

2015

J Neurol Neurophysiol

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CaseA 72 year-old man with a longstanding past medical history of hypertension and restless legs syndrome presented with a chief complaint of unsteadiness and oscillopsia that he reported as starting abruptly three months previously, with rapid deterioration. As the unsteadiness progressed, it also became associated with nausea, to which he attributed an unintentional 10-pound weight loss over 1 month. He denied any other symptoms, including other stigmata of malignancy (new cough, bleeding in the urine or stool). He did not drink alcohol, but smoked 1 pack of cigarettes per day. His only medications were lisinopril and gabapentin. He reported no family medical history.Some of his workup had been completed before he presented to our clinic. Audiometry showed presbycusis. MRI of the brain and internal auditory canals without and with contrast was normal; specifically, there were no abnormalities in the cerebellum. Lumbar puncture reported cerebrospinal fluid protein elevated at 70 (normal 15 -45), IgG elevated at 4.38 (normal 0.00 -3.40), albumin elevated at 47.50 (normal 0.00 -34.99). Lyme disease antibody screen was negative and myelin basic protein was <2.0 (normal 0 -4.0). Serum antibodies to Hu, Yo and Ri were negative. He came to clinic in a wheelchair because he was unable to ambulate or transfer independently. On physical examination he had spontaneous upbeat nystagmus on primary position of gaze (16 deg/sec in the dark, diminished to 6 deg/sec with fixation; see Figure 1 and Video), which also intruded into smooth pursuit. The upbeat nystagmus did not change at the extremes of lateral gaze, nor did it depend on position with respect to gravity. The remainder of his examination, including appendicular cerebellar function, was normal.Having examined him in clinic, we referred him immediately for CT of the chest, abdomen and pelvis without and with oral and intravenous contrast, which revealed a 2 cm solid focal partially exophytic mass in the left kidney.Subsequent workup included MRI of the abdomen that demonstrated the same renal mass. An F18 FDG PET scan showed increased uptake in this renal mass, as well as mildly increased uptake in a precarinal lymph node. Transbronchial needle biopsy of a right paratracheal lymph node was negative for carcinoma and lymphoma. A separate FDGPET/CT study showed increased uptake in a right abdominal precaval mesenteric lymph node; needle biopsy found this to be inflammatory, without evidence of malignancy. A second lumbar puncture had an opening pressure of 120 mm H2O. Cerebrospinal fluid had a protein of 112 and a lymphocytic pleocytosis of 16 and no red cells; IgG index and synthesis were normal; oligoclonal bands were negative; cytology was negative. Cerebrospinal fluid infectious studies were negative, including VDRL, Blastomyces, Coccidioides, Cryptococcus, yeast, fungi, adenovirus, LaCrosse encephalitis virus, cytomegalovirus, Epstein-Barr virus, Herpes simplex virus 1/2, HHV6, JC virus, St. Louis enephalitus virus, Varicella zoster virus, Eastern and Western equi...

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Upbeat nystagmus in anti-Ma2 encephalitis

Cited by 20 publications

References 8 publications

Anti-Ma2 Antibody Encephalitis Manifesting as Cognitive Impairment and Psychosis

Anti-Ma2 Antibody Encephalitis Manifesting as Cognitive Impairment and Psychosis

Movement disorders associated with neuronal antibodies

Paraneoplastic Upbeat Nystagmus in Renal Cell Carcinoma

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