Alberto Vogrig1,2,3,4, Bastien Joubert2,3,4, Francois Ducray2,3,4, Laure Thomas2,3,4, Cristina Izquierdo2,3,4, Kévin Decaestecker5, Olivier Martinaud6,7, Emmanuel Gerardin8, Sylvie Grand9, Jérome Honnorat10,11,12,13. 1. Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy. 2. French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France. 3. Synatac Team, NeuroMyoGene Institut, INSERM U1217/CNRS, UMR5310, Lyon, France. 4. University Claude Bernard Lyon 1, Lyon, France. 5. Department of Neurosurgery, Rouen University Hospital, Rouen, France. 6. Department of Neurology, Rouen University Hospital, Rouen, France. 7. Normandie Univ, UNICAEN, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France. 8. Department of Neuroradiology, Rouen University Hospital, Rouen, France. 9. Department of Neuroradiology, Grenoble University Hospital, Grenoble, France. 10. French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France. jerome.honnorat@chu-lyon.fr. 11. Synatac Team, NeuroMyoGene Institut, INSERM U1217/CNRS, UMR5310, Lyon, France. jerome.honnorat@chu-lyon.fr. 12. University Claude Bernard Lyon 1, Lyon, France. jerome.honnorat@chu-lyon.fr. 13. Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France. jerome.honnorat@chu-lyon.fr.
Abstract
OBJECTIVE: To identify the clinical and radiological features that should raise suspicion for the autoimmune encephalitis (AE)-like presentation of glioblastoma. METHODS: This is an observational, retrospective case series of patients referred to the French National Reference Center on Paraneoplastic Neurological Diseases for suspected AE (possible, probable or definite, using the 2016 criteria) who later received a final diagnosis of glioblastoma according to 2016 WHO criteria. An extensive literature search was also conducted for similar existing cases. RESULTS: Between 2014 and 2016, 306 patients were referred to our center for suspected AE. Six of these patients (2%) later developed pathologically confirmed glioblastoma. Thirteen patients (9 male) were included for analysis (6 from the present series and 7 from the literature); median age was 63. Initially, a diagnosis of AE was clinically suspected based on: working memory deficits (77%), seizures (62%) (including status epilepticus in 23%), and psychiatric symptoms (46%). Initial brain MRI was not in favor of a typical glioblastoma pattern and showed bilateral (54%) or unilateral selective limbic involvement. Five patients exhibited initial slight contrast enhancement. A clear inflammatory CSF was present in five patients and three from the literature showed autoantibody positivity (NMDAR, VGKC, GluRepsilon2). Median delay between suspicions of AE to GBM diagnosis was 3 months (range 1.5-24) and one patient from the literature was diagnosed post-mortem. CONCLUSIONS: An alternative diagnosis of glioblastoma should be considered in patients presenting initially as AE, especially in patients who do not fulfill the criteria for definite AE and in those with a poor clinical evolution despite initial improvement.
OBJECTIVE: To identify the clinical and radiological features that should raise suspicion for the autoimmune encephalitis (AE)-like presentation of glioblastoma. METHODS: This is an observational, retrospective case series of patients referred to the French National Reference Center on Paraneoplastic Neurological Diseases for suspected AE (possible, probable or definite, using the 2016 criteria) who later received a final diagnosis of glioblastoma according to 2016 WHO criteria. An extensive literature search was also conducted for similar existing cases. RESULTS: Between 2014 and 2016, 306 patients were referred to our center for suspected AE. Six of these patients (2%) later developed pathologically confirmed glioblastoma. Thirteen patients (9 male) were included for analysis (6 from the present series and 7 from the literature); median age was 63. Initially, a diagnosis of AE was clinically suspected based on: working memory deficits (77%), seizures (62%) (including status epilepticus in 23%), and psychiatric symptoms (46%). Initial brain MRI was not in favor of a typical glioblastoma pattern and showed bilateral (54%) or unilateral selective limbic involvement. Five patients exhibited initial slight contrast enhancement. A clear inflammatory CSF was present in five patients and three from the literature showed autoantibody positivity (NMDAR, VGKC, GluRepsilon2). Median delay between suspicions of AE to GBM diagnosis was 3 months (range 1.5-24) and one patient from the literature was diagnosed post-mortem. CONCLUSIONS: An alternative diagnosis of glioblastoma should be considered in patients presenting initially as AE, especially in patients who do not fulfill the criteria for definite AE and in those with a poor clinical evolution despite initial improvement.
Authors: Alberto Vogrig; Gian Luigi Gigli; Samantha Segatti; Elisa Corazza; Alessandro Marini; Andrea Bernardini; Francesca Valent; Martina Fabris; Francesco Curcio; Francesco Brigo; Donatella Iacono; Paolo Passadore; Michele Rana; Jérôme Honnorat; Mariarosaria Valente Journal: J Neurol Date: 2019-09-24 Impact factor: 4.849
Authors: R J Slegers; T A M Bouwens van der Vlis; L Ackermans; A Hoeben; A A Postma; I Compter; J G J Hoeijmakers; J Beckervordersandforth; M P G Broen; O E M G Schijns Journal: Acta Neurochir (Wien) Date: 2021-10-29 Impact factor: 2.216