title: [Paraneoplastic cerebellar degeneration with bladder cancer confirmed the existence of an anti-neural antibody: a case report].
abstract: A 66-year-old man was diagnosed with bladder cancer at our urology department. Three months later, he developed subacute progressive cerebellar limb ataxia and truncal oscillation. Analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of protein, while brain magnetic resonance imaging revealed no abnormalities. Based on the presence of the bladder cancer, the etiology of subacute cerebellar ataxia could be a paraneoplastic neurological syndrome. Four months later, the patient underwent transurethral resection of the bladder tumor, which was identified as urothelial cancer on the basis of pathological examinations. However, this procedure failed to improve his neurological symptoms. Serum paraneoplastic markers such as anti-Yo, anti-Hu, anti-Tr, and other antibodies were not detected. Immunohistochemical staining of mouse cerebellum using the patient's serum revealed coarse granular staining in the cytoplasm of Purkinje cells and diffuse staining in the neuropil of the molecular layer, suggesting the presence of an unknown antibody. Subsequently, one-dimensional electrophoresis western blotting using the patient's serum revealed several bands including a strong positive band of approximately 45 kDa in mouse cerebellum lysates but not in liver lysates. These bands have never been detected in sera derived from healthy donors. These results suggested the presence of a novel antibody in the patient's serum that might recognize the approximately 45 kDa protein related to paraneoplastic cerebellar degeneration. Cases of paraneoplastic neurological syndrome associated with bladder cancer have rarely been reported. We concluded that the present case may be categorized as paraneoplastic neurological syndrome caused by an unknown antibody.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Jichi Medical University.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kawanishi
authors.forename: Mitsuya
authors.initials: M
authors.lastname: Morita
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakahara
authors.forename: Syuichi
authors.initials: S
authors.lastname: Tetsuka
authors.forename: Tom
authors.initials: T
authors.lastname: Kouki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tominaga
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Endo
authors.forename: Takashi
authors.initials: T
authors.lastname: Yashiro
authors.forename: Keiko
authors.initials: K
authors.lastname: Tanaka
authors.forename: Imaharu
authors.initials: I
authors.lastname: Nakano
mesh_terms: D000368:Aged; D000818:Animals; D001323:Autoantibodies / Q000097:blood*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D051379:Mice; D020362:Paraneoplastic Cerebellar Degeneration / Q000150:complications / Q000276:immunology* / Q000473:pathology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000601:surgery
chemical_list: D001323:Autoantibodies