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A Case of Anti P/Q Type VGCC Antibody Positive Small Lung Cell Carcinoma that Occured with Subacute Cerebellar Degeneration,Lambert-Eaton Myasthenic Syndrome,and Brainstem Encephalitis Shigemi Nagayama 1,2,3 , Fumihiko Koike 1 , Tetsuo Sakai 1 , Yasunobu Antoku 1 , Motohiro Yukitake 2 , Yasuo Kuroda 2 1Division of Neurology,Yanagawa Rehabilitation Hospital 2Division of Neurology,Department of Medicine,Saga University Faculity of Medicine 3Department of Neurology,Kanazawa Medical University Keyword: paraneoplastic cerebellar degeneration , Lambert-Eaton myasthenic syndrome (LEMS) , Brainstem encephalitis , 18F]-FDG-PET , P/Q-type VGCC antibody pp.1470-1474
Published Date 2008/12/1
DOI https://doi.org/10.11477/mf.1416100400
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Abstract

 A 62-year-old man was admitted to our hospital because of rapidly progressive dysarthria, truncal ataxia, and gait disturbance. High titers of the ProGRP and anti-P/Q-type VGCC antibody were detected in the serum. High accumulation of [18F] was detected at the hilus of the left lung on [18F]-FDG-PET scan. A high-frequency repetitive stimulation test of the median nerve yielded an incremental response. On the basis of these findings, a diagnosis of paraneoplastic cerebellar degeneration (PCD) and Lambert-Eaton myasthenic syndrome (LEMS) associated with small cell lung carcinoma (SCLC) was diagnosed. After intravenous immunoglobulin therapy (IVIg), methylprednisolone (m-PSL) pulse therapy, and other multidisciplinary concurrent treatments, a partial regression of the SCLC and a significant improvement in neurological symptoms were observed. However, ataxia relapsed and brainstem encephalitis developed 6 months later. A marginal improvement in neurological symptoms was observed with IVIg, m-PSL pulse therapy, and intravenous cyclophosphamide pulse therapy (IVCY). SCLC also recurred later. We hypothesized that VGCC of the brainstem was damaged by anti-P/Q-type VGCC antibody.

(Received: March 9,2007,Accepted: July 29,2008)


Copyright © 2008, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院

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