metricas
covid
Buscar en
Neurología (English Edition)
Toda la web
Inicio Neurología (English Edition) Cerebellar hypermetabolism: an alternative marker for diagnosis of paraneoplasti...
Journal Information

Statistics

Follow this link to access the full text of the article

Letter to the Editor
Cerebellar hypermetabolism: an alternative marker for diagnosis of paraneoplastic cerebellar degeneration
Hipermetabolismo cerebeloso: un marcador alternativo para el diagnóstico de degeneración cerebelosa paraneoplásica
Doruk Arslana,
Corresponding author
md.dorukarslan@icloud.com

Corresponding author.
, Fadime Sinem Ardıcb, Ozge Berna Gultekin-Zaima, Murat Tuncelc, Neyran Kertmend, Rahsan Gocmene, Fatma Gokcem Yildiza, Ersin Tana
a Hacettepe University, Department of Neurology, Ankara, Turkey
b Hacettepe University, Department of Internal Medicine, Ankara, Turkey
c Hacettepe University, Department of Nuclear Medicine, Ankara, Turkey
d Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
e Hacettepe University, Department of Radiology, Ankara, Turkey
Read
1297
Times
was read the article
282
Total PDF
1015
Total HTML
Share statistics
 array:21 [
  "pii" => "S2173580822000918"
  "issn" => "21735808"
  "doi" => "10.1016/j.nrleng.2022.08.003"
  "estado" => "S300"
  "fechaPublicacion" => "2023-07-01"
  "aid" => "1771"
  "copyrightAnyo" => "2022"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Neurologia. 2023;38:443-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173580822000931"
    "issn" => "21735808"
    "doi" => "10.1016/j.nrleng.2022.06.006"
    "estado" => "S300"
    "fechaPublicacion" => "2023-07-01"
    "aid" => "1770"
    "copyright" => "Sociedad Española de Neurología"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Neurologia. 2023;38:443"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Clinical profile&#44; antibiotic treatment&#44; and risk of stroke in patients with infective endocarditis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "443"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Perfil cl&#237;nico&#44; tratamiento antibi&#243;tico y riesgo de ictus en pacientes con endocarditis infecciosa"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Mart&#237;nez-Sell&#233;s"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Mart&#237;nez-Sell&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213485322000950"
        "doi" => "10.1016/j.nrl.2022.06.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485322000950?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000931?idApp=UINPBA00004N"
    "url" => "/21735808/0000003800000006/v1_202306201000/S2173580822000931/v1_202306201000/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Cerebellar hypermetabolism&#58; an alternative marker for diagnosis of paraneoplastic cerebellar degeneration"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "443"
        "paginaFinal" => "446"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Doruk Arslan, Fadime Sinem Ard&#305;c, Ozge Berna Gultekin-Zaim, Murat Tuncel, Neyran Kertmen, Rahsan Gocmen, Fatma Gokcem Yildiz, Ersin Tan"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Doruk"
            "apellidos" => "Arslan"
            "email" => array:1 [
              0 => "md.dorukarslan@icloud.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Fadime Sinem"
            "apellidos" => "Ard&#305;c"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ozge Berna"
            "apellidos" => "Gultekin-Zaim"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Murat"
            "apellidos" => "Tuncel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Neyran"
            "apellidos" => "Kertmen"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Rahsan"
            "apellidos" => "Gocmen"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Fatma Gokcem"
            "apellidos" => "Yildiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Ersin"
            "apellidos" => "Tan"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Hacettepe University&#44; Department of Neurology&#44; Ankara&#44; Turkey"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hacettepe University&#44; Department of Internal Medicine&#44; Ankara&#44; Turkey"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hacettepe University&#44; Department of Nuclear Medicine&#44; Ankara&#44; Turkey"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hacettepe University Cancer Institute&#44; Department of Medical Oncology&#44; Ankara&#44; Turkey"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Hacettepe University&#44; Department of Radiology&#44; Ankara&#44; Turkey"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hipermetabolismo cerebeloso&#58; un marcador alternativo para el diagn&#243;stico de degeneraci&#243;n cerebelosa paraneopl&#225;sica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2464
            "Ancho" => 3341
            "Tamanyo" => 507344
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0050"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A maximum intensity projection &#40;MIP&#41; PET image &#40;A&#41; reveals no sign of residual malignant disease &#40;arrows&#41;&#46; Fusion PET-CT images of brain &#40;B&#44; C&#41; show diffuse bilateral decreased 18 F-fluorodeoxyglucose &#40;FDG&#41; uptake in cerebellum&#46; T2W coronal &#40;D&#41; and axial &#40;E&#41; brain MR imaging demonstrate diffuse cerebellar atrophy&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The central nervous system &#40;CNS&#41; may be the target of detrimental cellular and humoral immune responses in the case of autoimmune disease&#46; These immune-mediated autoimmune disorders occur in paraneoplastic and non-paraneoplastic contexts&#44; creating a vast and heterogeneous distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of the most common paraneoplastic neurological syndromes &#40;PNS&#41; is paraneoplastic cerebellar degeneration &#40;PCD&#41;&#44; including various neurological disorders presenting with cerebellar dysfunction&#46; It is characterized by subacute pan-cerebellar symptoms in patients who usually begin with gait ataxia followed by dysarthria&#44; nystagmus&#44; and appendicular ataxia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Neurological dysfunction may occur before detecting the underlying cancer or up to several years after detection&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Therefore&#44; neurologists need to have a high level of suspicion&#44; leading to early detection of associated cancer&#46; Early detection and localization of the primary malignancy are necessary to eliminate the underlying cause and prevent metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Positron emission tomography &#40;PET&#41; using 18 F-fluorodeoxyglucose &#40;FDG&#41; is an effective diagnostic tool in the early detection of primary tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> On the other hand&#44; many recently published studies have reported that PET has significantly high sensitivity and specificity to detect primary malignancies and thus high accuracy in confirming the diagnosis of PCD&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> To the best of our knowledge&#44; we discuss an anti-YO antibody positive female patient&#44; one of the anti-onconeural antibodies found in PCD patients&#44; presenting with acute PCD symptoms as the first manifestation of malignancy&#46; The value of PET in the diagnosis and follow-up of PCD and long-term outcomes of the disease will be highlighted in a patient in whom we had difficulty detecting the primary malignancy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 43-year-old woman who presented with eight weeks of progressive vertigo&#44; diplopia&#44; and ataxia was admitted to our clinic&#46; Her initial complaints were dizziness&#44; nausea&#44; and vomiting&#44; and they were progressed within a month&#46; Over time&#44; she had trouble keeping her balance and mobilized with assistance&#46; Contrast-enhanced brain magnetic resonance imaging &#40;MRI&#41; showed no features &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>G-H&#41;&#46; In cerebrospinal fluid &#40;CSF&#41; analysis&#44; anti-YO antibodies were detected in CSF&#46; Tumor markers were negative&#44; and there was no weight loss&#46; Chest and abdomen CT were performed&#44; and left axillary lymphadenopathies were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Mammography and breast ultrasound were evaluated as within normal limits&#59; axillary ultrasound confirmed pathological lymph nodes in the left axilla&#46; Fine needle and tru-cut biopsy were performed from the pathological axillary lymph node&#46; Malignant epithelial cells were observed in cytology&#44; and the immunohistochemical study supported primary breast carcinoma&#46; Pathological FDG uptake in the left axilla was confirmed in the FDG-PET examination &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; C&#8211;D&#41;&#46; However&#44; right cerebellar asymmetric hypermetabolism was noted <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#8211;F&#41;&#46; After neoadjuvant chemotherapy and rituximab immunotherapy&#44; left modified radical mastectomy and axillary lymph node dissection were performed&#46; There was no significant improvement in cerebellar findings&#44; and the patient could not be ambulated after treatments&#46; Currently&#44; the patient continues chemoimmunotherapy and adjuvant radiotherapy treatment&#46; Although early-stage brain MRI was evaluated within normal limits&#44; cerebellar atrophy was observed in the control brain MRI examination one year later &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#8211;E&#41;&#46; Similarly&#44; although cerebellar hypermetabolism was noted in the early period PET examination&#44; it showed cerebellar hypometabolism in the one-year follow-up &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#8211;C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PCD is a heterogeneous group&#44; and cases differ in clinical features&#44; prognosis&#44; associated tumor&#44; and associated antibodies&#46; Cerebellar degeneration seems to be the predominant presentation and its pathophysiology is based on the formation of autoantibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Brain MRI is usually normal at the onset of the disease&#44; as in our case report&#44; and does not help diagnose PCD&#46; In some cases&#44; cerebellar atrophy has been demonstrated on MRI at later stages&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The role of FDG-PET in PNS is under development&#46; Increasingly&#44; the potential of this modality is being highlighted in various reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Choi et al&#46; have reported a case with cerebellar hypermetabolism instead of hypometabolism consistent with FDG-PET&#46; It was assumed that this was due to an acute inflammatory process associated with an immunological reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Additionally&#44; Sharma et al&#46; have also reported an antibody negative unique PCD case who had normal brain MRI&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> They showed the role of FDG-PET by demonstrating diffuse intense cerebellar hypermetabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Similarly&#44; in our case&#44; cerebellar hypermetabolism was observed in the early phase of PCD&#46; This is probably related to the inflammatory response observed in the early stage&#44; which could not be detected in brain MRI&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In one-year follow-up of our case&#44; cerebellar atrophy accompanied with cerebellar hypometabolism occurred&#46; Development of cerebellar atrophy has been reported in patients with PCD&#59; however&#44; this finding is far from being diagnostic since it only occurs in the advanced stages of the disease&#46; The use of PET in the early stage of PCD appears to be an alternative biomarker for antibody negative or MRI normal early-stage patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics statement</span><p id="par0020" class="elsevierStylePara elsevierViewall">Informed written consent was obtained from the patient&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Disclosures</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors report no disclosure relevant to the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Declaration of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:6 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Ethics statement"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Disclosures"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Funding"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Declaration of interest"
        ]
        4 => array:2 [
          "identificador" => "xack672151"
          "titulo" => "Acknowledgments"
        ]
        5 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1824
            "Ancho" => 3341
            "Tamanyo" => 432265
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A maximum intensity projection &#40;MIP&#41; PET image &#40;A&#41; shows increased 18 F-fluorodeoxyglucose &#40;FDG&#41; uptake in right cerebellum &#40;SUV max&#58;20&#41; &#40;arrowhead&#41; and left axillary lymph node &#40;SUV max&#58;7&#41; &#40;arrow&#41;&#46; Axial thorax CT &#40;B&#41;&#44; PET &#40;C&#41;&#44; and fusion PET-CT &#40;D&#41; images reveal increased FDG uptake in left axillary lymph node&#46; Fusion PET-CT images of brain &#40;E&#44; F&#41; demonstrate increased FDG uptake in right cerebellum&#46; T2W coronal &#40;G&#41; and axial &#40;H&#41; brain MR imaging show no features&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2464
            "Ancho" => 3341
            "Tamanyo" => 507344
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0050"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A maximum intensity projection &#40;MIP&#41; PET image &#40;A&#41; reveals no sign of residual malignant disease &#40;arrows&#41;&#46; Fusion PET-CT images of brain &#40;B&#44; C&#41; show diffuse bilateral decreased 18 F-fluorodeoxyglucose &#40;FDG&#41; uptake in cerebellum&#46; T2W coronal &#40;D&#41; and axial &#40;E&#41; brain MR imaging demonstrate diffuse cerebellar atrophy&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Innate and adaptive immune responses in the CNS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Waisman"
                            1 => "R&#46;S&#46; Liblau"
                            2 => "B&#46; Becher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1474-4422(15)00141-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Neurol"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "945"
                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26293566"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Rojas"
                            1 => "F&#46; Graus"
                            2 => "F&#46; Keime-Guibert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/wnl.55.5.713"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2000"
                        "volumen" => "55"
                        "paginaInicial" => "713"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10980743"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paraneoplastic cerebellar degeneration&#46; I&#46; A clinical analysis of 55 anti-Yo antibody-positive patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Peterson"
                            1 => "M&#46;K&#46; Rosenblum"
                            2 => "H&#46; Kotanides"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/wnl.42.10.1931"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "1992"
                        "volumen" => "42"
                        "paginaInicial" => "1931"
                        "paginaFinal" => "1937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1407575"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Navigating the paraneoplastic neurological syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Giannopoulou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00259-002-1005-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Nucl Med Mol Imaging"
                        "fecha" => "2003"
                        "volumen" => "30"
                        "paginaInicial" => "333"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12722733"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915018300753"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of &#91;18F&#93;fluoro-2-deoxyglucose-PET scanning in the diagnosis of paraneoplastic neurological disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Rees"
                            1 => "S&#46;F&#46; Hain"
                            2 => "M&#46;R&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/brain/124.11.2223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain"
                        "fecha" => "2001"
                        "volumen" => "124"
                        "paginaInicial" => "2223"
                        "paginaFinal" => "2231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11673324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of FDG-PET&#47;CT and paraneoplastic antibodies in diagnosing cancer in paraneoplastic neurological syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Vatankulu"
                            1 => "S&#46; Yilmaz Aksoy"
                            2 => "S&#46; Asa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.remn.2015.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Med Nucl Imagen Mol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "17"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26260889"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunological bases of paraneoplastic cerebellar degeneration and therapeutic implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Yshii"
                            1 => "C&#46; Bost"
                            2 => "R&#46; Liblau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fimmu.2020.00991"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Immunol"
                        "fecha" => "2020"
                        "volumen" => "11"
                        "paginaInicial" => "991"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32655545"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebellar hypermetabolism in paraneoplastic cerebellar degeneration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;D&#46; Choi"
                            1 => "J&#46;S&#46; Kim"
                            2 => "S&#46;H&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/jnnp.2005.075325"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol Neurosurg Psychiatry"
                        "fecha" => "2006"
                        "volumen" => "77"
                        "paginaInicial" => "525"
                        "paginaFinal" => "528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16543536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebellar hypermetabolism on <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT with normal MRI in a case of paraneoplastic cerebellar degeneration with negative antibodies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Sharma"
                            1 => "B&#46; Mazumdar"
                            2 => "P&#46; Chatterjee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.remn.2014.05.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Med Nucl Imagen Mol"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "79"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25001850"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paraneoplastic cerebellar degeneration associated with cerebellar hypermetabolism&#58; case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;T&#46;A&#46; Abdulaziz"
                            1 => "X&#46;Q&#46; Yu"
                            2 => "L&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/md.0000000000010717"
                      "Revista" => array:3 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2018"
                        "volumen" => "97"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack672151"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">None&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735808/0000003800000006/v1_202306201000/S2173580822000918/v1_202306201000/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9409"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003800000006/v1_202306201000/S2173580822000918/v1_202306201000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000918?idApp=UINPBA00004N"
]
Article information
ISSN: 21735808
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 4 1 5
2024 October 27 13 40
2024 September 32 11 43
2024 August 29 15 44
2024 July 33 13 46
2024 June 34 7 41
2024 May 40 23 63
2024 April 47 9 56
2024 March 37 7 44
2024 February 61 8 69
2024 January 81 14 95
2023 December 61 12 73
2023 November 81 13 94
2023 October 111 16 127
2023 September 94 6 100
2023 August 61 6 67
2023 July 89 12 101
2023 June 30 14 44
2023 May 32 12 44
2023 April 31 3 34
2023 March 0 7 7
2023 February 0 3 3
2023 January 0 25 25
2022 December 0 5 5
2022 November 0 15 15
2022 October 0 5 5
2022 September 0 7 7
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos