Letter to the Editor
Rapid, severe neurological impairment associated with paraneoplastic cerebellar degeneration and anti-Yo antibodies
Deterioro neurológico rápido y severo asociado a degeneración cerebelosa paraneoplásica con anticuerpos anti-Yo positivos
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Cadavid, J.C. Diaz, A. Masaru Shinchi, Y. Jesualdo Ariza" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Cadavid" "email" => array:1 [ 0 => "dahianacadavidaljure@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.C." "apellidos" => "Diaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Masaru Shinchi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Y." "apellidos" => "Jesualdo Ariza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Medicina Interna, Universidad CES, Medellín, Colombia, Fundación Valle del Lili, Cali, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Fundación Valle del Lili, Cali, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Epidemiología, Universidad ICESI, Cali, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Deterioro neurológico rápido y severo asociado a degeneración cerebelosa paraneoplásica con anticuerpos anti-Yo positivos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 950 "Ancho" => 951 "Tamanyo" => 126618 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography with contrast in early portal venous phase: retroperitoneal mass proximate to the third part of the duodenum, with no masses in the ovaries or adjacent structures.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paraneoplastic cerebellar degeneration (PCD)<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> is a rare syndrome that most frequently occurs in women with gynaecological cancer.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is characterised by extensive loss of Purkinje cells which are targeted by antibodies (anti-Yo, anti-Tr)<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a>; these antibodies may be detected in serum and/or cerebrospinal fluid (CSF).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> These syndromes manifest with pancerebellar symptoms including vertigo, ataxia, dysarthria, and nystagmus.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Symptoms are usually expressed during the underlying tumour's early stages of development, which means that any occult neoplasia should be located urgently.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 69-year-old woman treated at our hospital for left gaze deviation, generalised hypotonia followed by limb hypertonia, and loss of consciousness lasting approximately 5<span class="elsevierStyleHsp" style=""></span>minutes. Medical history included arterial hypertension and hypothyroidism, both of which were controlled. She had lost 8<span class="elsevierStyleHsp" style=""></span>kg in the preceding 6 months and also experienced difficulty walking, blurred vision, and difficulty speaking in the week prior to hospital admission. Examination showed normal vital signs. The patient was alert and oriented, displaying dysarthria, difficulty following directions, saccadic eye movements, vertical nystagmus, and pronounced left-sided dysmetria on the finger-to-nose test. The patient was unable to perform the heel-to-knee-to-shin test; tendon reflexes, cranial nerves, and sensitivity showed no alterations. Complementary tests showed normal blood count and renal function, no positive ELISA tests for HIV or other entities, normal vitamin B<span class="elsevierStyleInf">12</span> levels, and normal CSF results (cytochemistry, direct study, and cultures). Brain MRI with gadolinium contrast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed microangiopathic leukoencephalopathy with no lesions in the posterior fossa and normal MRA. Based on this evidence, doctors suspected PCD. Doctors extended the search for a primary tumour by ordering a thoracic CT and mammary ultrasound; both yielded normal results. Abdominal and pelvic CT (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) revealed a retroperitoneal mass proximate to the third part of the duodenum with no masses in ovaries or adjacent structures. The mass was resected and determined to be a retroperitoneal lymph node with poorly differentiated metastatic adenocarcinoma. The immunohistochemical study was inconclusive. The Western blot test was used to check for anti-Hu and anti-Yo antibodies, and the latter were detected. The patient was started on steroid treatment at 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day, but progress was poor. Cerebellar symptoms evolved rapidly, and the patient was unable to walk or swallow less than 7 days after being admitted. Due to the patient's rapid clinical decline and poor prognosis, doctors decided not to undertake further studies or provide any treatments (plasmapheresis, immunoglobulin) that might worsen her clinical state without providing significant benefits, as has been described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> This case generates concern about the benefits of searching for the primary tumour and using full immunosuppression in patients with PCD and anti-Yo antibodies. This situation gives rise to a survival time of between 13 and 22 months, and oncological treatment has no effect on the functional outcome; patient decline tends to be rapid and pronounced.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,11,15</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cadavid D, Diaz JC, Masaru Shinchi A, Jesualdo Ariza Y. Deterioro neurológico rápido y severo asociado a degeneración cerebelosa paraneoplásica con anticuerpos anti-Yo positivos. Neurología. 2014;29:128–129.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 839 "Ancho" => 951 "Tamanyo" => 106988 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gadolinium-enhanced FLAIR (fluid-attenuated inversion-recovery) magnetic resonance image of the brain: microangiopathic leukoencephalopathy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 950 "Ancho" => 951 "Tamanyo" => 126618 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography with contrast in early portal venous phase: retroperitoneal mass proximate to the third part of the duodenum, with no masses in the ovaries or adjacent structures.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Degeneración cerebelosa paraneoplásica como inicio de un carcinoma indiferenciado de células pequeñas de páncreas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 15 | 3 | 18 |
| 2024 September | 23 | 3 | 26 |
| 2024 August | 19 | 5 | 24 |
| 2024 July | 12 | 2 | 14 |
| 2024 June | 10 | 8 | 18 |
| 2024 May | 12 | 11 | 23 |
| 2024 April | 19 | 31 | 50 |
| 2024 March | 20 | 4 | 24 |
| 2024 February | 19 | 5 | 24 |
| 2024 January | 20 | 4 | 24 |
| 2023 December | 29 | 10 | 39 |
| 2023 November | 19 | 8 | 27 |
| 2023 October | 24 | 14 | 38 |
| 2023 September | 11 | 4 | 15 |
| 2023 August | 6 | 6 | 12 |
| 2023 July | 14 | 11 | 25 |
| 2023 June | 20 | 2 | 22 |
| 2023 May | 38 | 8 | 46 |
| 2023 April | 43 | 3 | 46 |
| 2023 March | 13 | 2 | 15 |
| 2023 February | 18 | 1 | 19 |
| 2023 January | 32 | 14 | 46 |
| 2022 December | 14 | 4 | 18 |
| 2022 November | 13 | 5 | 18 |
| 2022 October | 8 | 9 | 17 |
| 2022 September | 23 | 9 | 32 |
| 2022 August | 12 | 7 | 19 |
| 2022 July | 7 | 7 | 14 |
| 2022 June | 11 | 8 | 19 |
| 2022 May | 12 | 11 | 23 |
| 2022 April | 9 | 4 | 13 |
| 2022 March | 12 | 5 | 17 |
| 2022 February | 7 | 3 | 10 |
| 2022 January | 9 | 7 | 16 |
| 2021 December | 10 | 11 | 21 |
| 2021 November | 9 | 9 | 18 |
| 2021 October | 17 | 14 | 31 |
| 2021 September | 9 | 9 | 18 |
| 2021 August | 9 | 5 | 14 |
| 2021 July | 10 | 10 | 20 |
| 2021 June | 13 | 8 | 21 |
| 2021 May | 11 | 7 | 18 |
| 2021 April | 21 | 29 | 50 |
| 2021 March | 18 | 9 | 27 |
| 2021 February | 8 | 10 | 18 |
| 2021 January | 11 | 14 | 25 |
| 2020 December | 10 | 8 | 18 |
| 2020 November | 9 | 6 | 15 |
| 2020 October | 5 | 3 | 8 |
| 2020 September | 8 | 10 | 18 |
| 2020 August | 12 | 6 | 18 |
| 2020 July | 8 | 9 | 17 |
| 2020 June | 11 | 8 | 19 |
| 2020 May | 12 | 8 | 20 |
| 2020 April | 8 | 4 | 12 |
| 2020 March | 20 | 7 | 27 |
| 2020 February | 15 | 8 | 23 |
| 2020 January | 13 | 5 | 18 |
| 2019 December | 14 | 8 | 22 |
| 2019 November | 9 | 1 | 10 |
| 2019 October | 10 | 3 | 13 |
| 2019 September | 8 | 1 | 9 |
| 2019 August | 7 | 1 | 8 |
| 2019 July | 15 | 12 | 27 |
| 2019 June | 16 | 7 | 23 |
| 2019 May | 51 | 10 | 61 |
| 2019 April | 33 | 18 | 51 |
| 2019 March | 5 | 2 | 7 |
| 2019 February | 7 | 13 | 20 |
| 2019 January | 4 | 1 | 5 |
| 2018 December | 6 | 4 | 10 |
| 2018 November | 8 | 2 | 10 |
| 2018 October | 13 | 3 | 16 |
| 2018 September | 7 | 0 | 7 |
| 2018 August | 1 | 3 | 4 |
| 2018 July | 13 | 5 | 18 |
| 2018 June | 4 | 4 | 8 |
| 2018 May | 5 | 3 | 8 |
| 2018 April | 7 | 5 | 12 |
| 2018 March | 4 | 8 | 12 |
| 2018 February | 3 | 3 | 6 |
| 2018 January | 11 | 2 | 13 |
| 2017 December | 2 | 1 | 3 |
| 2017 November | 9 | 6 | 15 |
| 2017 October | 10 | 5 | 15 |
| 2017 September | 11 | 10 | 21 |
| 2017 August | 18 | 4 | 22 |
| 2017 July | 8 | 3 | 11 |
| 2017 June | 10 | 14 | 24 |
| 2017 May | 7 | 3 | 10 |
| 2017 April | 13 | 5 | 18 |
| 2017 March | 16 | 41 | 57 |
| 2017 February | 14 | 1 | 15 |
| 2017 January | 13 | 4 | 17 |
| 2016 December | 22 | 11 | 33 |
| 2016 November | 20 | 4 | 24 |
| 2016 October | 20 | 9 | 29 |
| 2016 September | 24 | 6 | 30 |
| 2016 August | 28 | 8 | 36 |
| 2016 July | 20 | 1 | 21 |
| 2016 June | 24 | 15 | 39 |
| 2016 May | 22 | 29 | 51 |
| 2016 April | 17 | 19 | 36 |
| 2016 March | 20 | 15 | 35 |
| 2016 February | 21 | 6 | 27 |
| 2016 January | 16 | 4 | 20 |
| 2015 December | 20 | 8 | 28 |
| 2015 November | 19 | 3 | 22 |
| 2015 October | 22 | 6 | 28 |
| 2015 September | 29 | 8 | 37 |
| 2015 August | 28 | 9 | 37 |
| 2015 July | 22 | 7 | 29 |
| 2015 June | 8 | 0 | 8 |
| 2015 May | 9 | 5 | 14 |
| 2015 April | 21 | 16 | 37 |
| 2015 March | 23 | 8 | 31 |
| 2015 February | 20 | 4 | 24 |
| 2015 January | 23 | 3 | 26 |
| 2014 December | 37 | 9 | 46 |
| 2014 November | 14 | 6 | 20 |
| 2014 October | 24 | 6 | 30 |
| 2014 September | 24 | 5 | 29 |
| 2014 August | 26 | 7 | 33 |
| 2014 July | 23 | 5 | 28 |
| 2014 June | 20 | 4 | 24 |
| 2014 May | 13 | 10 | 23 |
| 2014 April | 18 | 9 | 27 |
| 2014 March | 21 | 8 | 29 |
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