title: Paraneoplastic coma and acquired central alveolar hypoventilation as a manifestation of brainstem encephalitis in a patient with ANNA-1 antibody and small-cell lung cancer.
abstract: BACKGROUND
  Paraneoplastic neurological disorders are a well recognized complication of malignancy.
  
  
  METHODS
  A case report to expand the currently described clinical manifestations of type 1 antineuronal antibody (ANNA-1)-associated paraneoplastic encephalomyelitis to include coma.
  
  
  RESULTS
  We present an unusual case of fluctuating coma and rapid fulminant progression to acute respiratory failure from central alveolar hypoventilation caused by ANNA-1 paraneoplastic encephalomyelitis associated with small-cell lung carcinoma. Paraneoplastic infiltration of the brainstem and cerebellum, including respiratory and arousal centers, was documented on autopsy.
  
  
  CONCLUSIONS
  Paraneoplastic encephalomyelitis should be considered as a possible cause of coma and central alveolar hypoventilation.
authors.affiliation: Department of Critical Care, Mayo Clinic, Scottsdale, AZ 85054, USA.
authors.forename: Kwan S
authors.initials: KS
authors.lastname: Lee
authors.forename: Michaela J
authors.initials: MJ
authors.lastname: Higgins
authors.forename: Bhavesh M
authors.initials: BM
authors.lastname: Patel
authors.forename: Joel S
authors.initials: JS
authors.lastname: Larson
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Rady
mesh_terms: D000368:Aged; D000912:Antibodies, Neoplasm / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D001933:Brain Stem / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000150:complications / Q000276:immunology / Q000473:pathology; D003128:Coma / Q000150:complications*; D003937:Diagnosis, Differential; D051959:ELAV Proteins / Q000276:immunology*; D004679:Encephalomyelitis / Q000150:complications* / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000276:immunology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009419:Nerve Tissue Proteins / Q000276:immunology; D009474:Neurons / Q000276:immunology; D010257:Paraneoplastic Syndromes / Q000150:complications / Q000276:immunology / Q000473:pathology; D020182:Sleep Apnea, Central / Q000150:complications* / Q000175:diagnosis*
chemical_list: D000912:Antibodies, Neoplasm; D001323:Autoantibodies; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins