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Late-onset subacute chorea.

Pedro Fraiman1, Kaliny Oliveira Peixoto2, Rodrigo Alencar E Silva2

  • 1Division of General Neurology, Ataxia and Neurorheumatology Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil pedro.fraiman@unifesp.br.

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Summary
This summary is machine-generated.

This case study presents a rare instance of paraneoplastic striatal encephalitis, a condition causing late-onset chorea. Early detection of neuronal antibodies and malignancy is crucial for potential intervention.

Keywords:
MOVEMENT DISORDERSNEUROIMMUNOLOGYPARANEOPLASTIC SYNDROME

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Area of Science:

  • Neurology
  • Oncology
  • Immunology

Background:

  • Late-onset behavioral changes can mimic psychiatric disorders like bipolar disorder.
  • Generalized chorea and weight loss are significant neurological and systemic symptoms.
  • Paraneoplastic syndromes can manifest with diverse and delayed neurological symptoms.

Purpose of the Study:

  • To highlight paraneoplastic striatal encephalitis as a cause of late-onset chorea.
  • To emphasize the potential for psychiatric symptoms to precede neurological manifestations.
  • To underscore the importance of investigating neuronal antibodies and malignancy in specific clinical presentations.

Main Methods:

  • Case report of a 71-year-old woman with late-onset behavioral changes.
  • Clinical examination revealing hyperkinetic movements, frontal, and oculomotor features.
  • Brain MRI showing bilateral striatal T2 FLAIR hyperintensities.
  • Laboratory analysis of serum and cerebrospinal fluid for neuronal antibodies (anticollapsin response mediator protein 5/CV2 and anti-neuronal nuclear antibody type 1/Hu).
  • Imaging to identify an underlying thoracic malignancy.

Main Results:

  • The patient presented with behavioral changes, later developing chorea and weight loss.
  • Brain MRI revealed characteristic striatal hyperintensities.
  • Positive results for anticollapsin response mediator protein 5/CV2 and anti-neuronal nuclear antibody type 1/Hu antibodies were found.
  • An underlying thoracic malignancy was identified.
  • The patient did not respond to immunotherapy and had a poor outcome.

Conclusions:

  • Paraneoplastic striatal encephalitis is a critical consideration for late-onset chorea.
  • Psychiatric symptoms may be the initial presentation years before neurological signs.
  • Subacute progression, systemic symptoms, and specific MRI findings warrant investigation for paraneoplastic causes.