Case 27-2012: A 60-year-old woman with painful muscle spasms and hyperreflexia

New England Journal of Medicine

Volumn 367, Issue 9, 2012, Pages 851-861

  Byrne, Thomas N ^a,b   Isakoff, Steven Jay ^a,b   Rincon, Sandra P ^a,b   Gudewicz, Thomas M ^a,b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

4 AMINOBUTYRIC ACID; AMPHIPHYSIN ANTIBODY; ANASTROZOLE; ANTICONVULSIVE AGENT; ATORVASTATIN; BACLOFEN; CETIRIZINE; CYCLOBENZAPRINE; CYCLOPHOSPHAMIDE; CYTOKERATIN 7; DIAZEPAM; DIPHENHYDRAMINE; DOXORUBICIN; EPIDERMAL GROWTH FACTOR RECEPTOR 2; ESTROGEN RECEPTOR; GABAPENTIN; GADOLINIUM; GLUCOCORTICOID; GLUTAMATE DECARBOXYLASE ANTIBODY; IMMUNOGLOBULIN; IMMUNOGLOBULIN G ANTIBODY; LORAZEPAM; MORPHINE; NARCOTIC ANALGESIC AGENT; OLIGOCLONAL BAND; PACLITAXEL; PREDNISONE; PROGESTERONE RECEPTOR; RITUXIMAB; THYROID TRANSCRIPTION FACTOR 1; UNCLASSIFIED DRUG; AMPHIPHYSIN; ANTIBODY; NERVE PROTEIN;

AGITATION; AMNESIA; AMYGDALOID NUCLEUS; ARTICLE; AXILLARY LYMPH NODE; BREAST CANCER; CANCER ADJUVANT THERAPY; CANCER OF UNKNOWN PRIMARY SITE; CERVICAL SPINE; CHRONIC PAIN; CLONUS; COGNITIVE DEFECT; COMPUTER ASSISTED TOMOGRAPHY; CONFABULATION; CONFUSION; CONTRAST ENHANCEMENT; DIFFERENTIAL DIAGNOSIS; DISORIENTATION; DIZZINESS; DRUG DOSE REDUCTION; DRUG MEGADOSE; EPILEPTIC STATE; FALLING; FIBROMYALGIA; FOLLOW UP; HERPES SIMPLEX ENCEPHALITIS; HIPPOCAMPUS; HOSPITAL READMISSION; HUMAN; HYPERREFLEXIA; IMMUNOHISTOCHEMISTRY; LEG CRAMP; LEG PAIN; LOW BACK PAIN; LUMBAR PUNCTURE; LUMBAR SPINE; LYMPH NODE BIOPSY; LYMPH NODE METASTASIS; MAMMOGRAPHY; MASTECTOMY; MUSCLE CRAMP; MUSCLE RIGIDITY; MUSCLE SPASM; MUSCLE STIFFNESS; MUSCLE TONE; NEUROIMAGING; NUCLEAR MAGNETIC RESONANCE IMAGING; PAIN ASSESSMENT; PARAHIPPOCAMPAL GYRUS; PARANEOPLASTIC NEUROPATHY; PARANEOPLASTIC SYNDROME; PARANOIA; PLEOCYTOSIS; PRIORITY JOURNAL; PRURITUS; PSYCHOSIS; SHORT TERM MEMORY; SPASTICITY; SPINAL CORD DISEASE; STIFF MAN SYNDROME; TEMPORAL LOBE; WALKING AID; WEAKNESS; WHITE MATTER; BACKACHE; BLOOD; BRAIN; BREAST TUMOR; CASE REPORT; CLINICAL OBSERVATION; CLINICAL STUDY; DIAGNOSIS; FEMALE; IMMUNOLOGY; LYMPH NODE; MEMORY DISORDER; MIDDLE AGED; PAGET NIPPLE DISEASE; PATHOLOGICAL REFLEX; PATHOLOGY;

ANTIBODIES; BACK PAIN; BRAIN; BREAST NEOPLASMS; CARCINOMA, DUCTAL, BREAST; DIAGNOSIS, DIFFERENTIAL; FEMALE; HUMANS; LIMBIC ENCEPHALITIS; LYMPH NODES; LYMPHATIC METASTASIS; MAGNETIC RESONANCE IMAGING; MEMORY DISORDERS; MIDDLE AGED; NEOPLASMS, UNKNOWN PRIMARY; NERVE TISSUE PROTEINS; REFLEX, ABNORMAL; SPASM; STIFF-PERSON SYNDROME;

EID: 84865465580     PISSN: 00284793     EISSN: 15334406     Source Type: Journal    
DOI: 10.1056/NEJMcpc1114036     Document Type: Article

References (20)

1. Solimena M, Folli F, Aparisi R, Pozza G, De Camilli P. Autoantibodies to GABAergic neurons and pancreatic beta cells in stiff-man syndrome. N Engl J Med 1990; 322:1555-60.
2. Murinson BB, Guarnaccia JB. Stiffperson syndrome with amphiphysin antibodies: distinctive features of a rare disease. Neurology 2008;71:1955-8.
3. Alexopoulos H, Dalakas MC. A critical update on the immunopathogenesis of Stiff Person Syndrome. Eur J Clin Invest 2010;40:1018-25.
4. Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003;349:1543-54.
5. Graus F, Delattre JY, Antoine JC, et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004;75: 1135-40.
6. Roberts WK, Darnell RB. Neuroimmunology of the paraneoplastic neurological degenerations. Curr Opin Immunol 2004;16:616-22.
7. Case Records of the Massachusetts General Hospital (Case 26-2008). N Engl J Med 2008;359:842-53.
8. Sommer C, Weishaupt A, Brinkhoff J, et al. Paraneoplastic stiff-person syndrome: passive transfer to rats by means of IgG antibodies to amphiphysin. Lancet 2005;365:1406-11.
9. Psimaras D, Carpentier AF, Rossi C. Cerebrospinal fluid study in paraneoplastic syndromes. J Neurol Neurosurg Psychiatry 2010;81:42-5.
10. Pittock SJ, Lucchinetti CF, Parisi JE, et al. Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 2005;58:96-107.
11. Buchanan CL, Morris EA, Dorn PL, Borgen PI, Van Zee KJ. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol 2005;12:1045-53.
12. Halsted WS. I. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 1907;46:1-19.
13. Walker GV, Smith GL, Perkins GH, et al. Population-based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer 2010;116:4000-6.
14. Foroudi F, Tiver KW. Occult breast carcinoma presenting as axillary metastases. Int J Radiat Oncol Biol Phys 2000; 47:143-7.
15. Masinghe SP, Faluyi OO, Kerr GR, Kunkler IH. Breast radiotherapy for occult breast cancer with axillary nodal metastases - does it reduce the local recurrence rate and increase overall survival? Clin Oncol (R Coll Radiol) 2011;23:95-100.
16. Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol 1990;21:518-23.
17. Dalakas MC. Stiff person syndrome: advances in pathogenesis and therapeutic interventions. Curr Treat Options Neurol 2009;11:102-10.
18. Donofrio PD, Berger A, Brannagan TH III, et al. Consensus statement: the use of intravenous immunoglobulin in the treatment of neuromuscular conditions: report of the AANEM ad hoc committee. Muscle Nerve 2009;40:890-900.
19. Greenlee JE. Treatment of paraneoplastic neurologic disorders. Curr Treat Options Neurol 2010;12:212-30.
20. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer. J Clin Oncol 2003;21:1431-9. [Erratum, J Clin Oncol 2003;21:2226.]