TAILIEUCHUNG - Chapter 097. Paraneoplastic Neurologic Syndromes (Part 7)

Encephalitis and Encephalomyelitis: Treatment Most types of paraneoplastic encephalitis and encephalomyelitis respond poorly to treatment. Stabilization of symptoms or partial neurologic improvement may occasionally occur, particularly if there is a satisfactory response of the tumor to treatment. The roles of plasma exchange, IVIg, and immunosuppression have not been established. Approximately 30% of patients with anti-Ma2-associated encephalitis respond to treatment of the tumor (usually a germ-cell neoplasm of the testis) and immunotherapy. Two other syndromes that are responsive to treatment of the tumor and immunotherapy are the encephalitis that associates with antibodies to the NR1/NR2 subunits of NMDA receptors in patients. | Chapter 097. Paraneoplastic Neurologic Syndromes Part 7 Encephalitis and Encephalomyelitis Treatment Most types of paraneoplastic encephalitis and encephalomyelitis respond poorly to treatment. Stabilization of symptoms or partial neurologic improvement may occasionally occur particularly if there is a satisfactory response of the tumor to treatment. The roles of plasma exchange IVIg and immunosuppression have not been established. Approximately 30 of patients with anti-Ma2-associated encephalitis respond to treatment of the tumor usually a germ-cell neoplasm of the testis and immunotherapy. Two other syndromes that are responsive to treatment of the tumor and immunotherapy are the encephalitis that associates with antibodies to the NR1 NR2 subunits of NMDA receptors in patients with teratoma of the ovary and the encephalitis that associates with VGKC antibodies in some patients with thymoma or SCLC. Paraneoplastic Cerebellar Degeneration This disorder is often preceded by a prodrome that may include dizziness oscillopsia blurry or double vision nausea and vomiting. A few days or weeks later dysarthria gait and limb ataxia and variable dysphagia can appear. The examination usually shows downbeating nystagmus and rarely opsoclonus. Brainstem dysfunction upgoing toes or a mild neuropathy may occur but more often the symptoms and signs are restricted to the cerebellum. Early in the course MRI studies are usually normal later the MRI typically reveals cerebellar atrophy. The disorder results from extensive degeneration of Purkinje cells with variable involvement of other cerebellar cortical neurons deep cerebellar nuclei and spinocerebellar tracts. The tumors more frequently involved are SCLC cancer of the breast and ovary and Hodgkin s lymphoma. Anti-Yo antibodies in patients with breast and gynecologic cancers and anti-Tr antibodies in patients with Hodgkin s lymphoma are the two paraneoplastic antibodies typically associated with prominent or pure cerebellar .

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