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Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials

Anti-Myelin Associated Glycoprotein (anti-MAG) neurological involvement classically manifests as a peripheral neuropathy with prominent sensitive symptoms. We describe a case report of a patient with positive anti-MAG antibodies presenting with clinical and neurophysiological evidence of spinal cord...

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Autores principales: Boscarino, Marilisa, Lanzone, Jacopo, Ricci, Lorenzo, Tombini, Mario, Di Lazzaro, Vincenzo, Assenza, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287849/
https://www.ncbi.nlm.nih.gov/pubmed/32397154
http://dx.doi.org/10.3390/brainsci10050282
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author Boscarino, Marilisa
Lanzone, Jacopo
Ricci, Lorenzo
Tombini, Mario
Di Lazzaro, Vincenzo
Assenza, Giovanni
author_facet Boscarino, Marilisa
Lanzone, Jacopo
Ricci, Lorenzo
Tombini, Mario
Di Lazzaro, Vincenzo
Assenza, Giovanni
author_sort Boscarino, Marilisa
collection PubMed
description Anti-Myelin Associated Glycoprotein (anti-MAG) neurological involvement classically manifests as a peripheral neuropathy with prominent sensitive symptoms. We describe a case report of a patient with positive anti-MAG antibodies presenting with clinical and neurophysiological evidence of spinal cord impairment. A 69-year-old woman came to our attention with subacute onset of dysesthesias at lower limbs and ataxia. Blood routine tests and hematological work-up led to a diagnosis of monoclonal gammopathy of undetermined significance. High titers of anti-MAG antibodies was revealed (34,594.70 BTU/mL, normal range 0–1000). Nerve conduction studies (NCS) ruled out a polyneuropathy at lower limbs. Somatosensory evoked potentials (SSEPs) showed prolonged central conduction time (CTT) at lower limbs, suggesting a dorsal column damage. Brain and spinal cord Magnetic Resonance Imaging (MRI) did not reveal any significant lesion. Analysis of cerebrospinal fluid (CSF) evidenced an albumin-cytologic dissociation. She was treated with corticosteroids with temporary remission of sensory symptoms and normalization of CTT. Subsequently, she developed a multineuropathy which was successfully treated with Rituximab. We discuss the potential role of anti-MAG antibodies in the pathophysiology of dorsal column impairment and the clinical usefulness of SSEPs in monitoring the evolution of anti-MAG neuropathy.
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spelling pubmed-72878492020-06-15 Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials Boscarino, Marilisa Lanzone, Jacopo Ricci, Lorenzo Tombini, Mario Di Lazzaro, Vincenzo Assenza, Giovanni Brain Sci Case Report Anti-Myelin Associated Glycoprotein (anti-MAG) neurological involvement classically manifests as a peripheral neuropathy with prominent sensitive symptoms. We describe a case report of a patient with positive anti-MAG antibodies presenting with clinical and neurophysiological evidence of spinal cord impairment. A 69-year-old woman came to our attention with subacute onset of dysesthesias at lower limbs and ataxia. Blood routine tests and hematological work-up led to a diagnosis of monoclonal gammopathy of undetermined significance. High titers of anti-MAG antibodies was revealed (34,594.70 BTU/mL, normal range 0–1000). Nerve conduction studies (NCS) ruled out a polyneuropathy at lower limbs. Somatosensory evoked potentials (SSEPs) showed prolonged central conduction time (CTT) at lower limbs, suggesting a dorsal column damage. Brain and spinal cord Magnetic Resonance Imaging (MRI) did not reveal any significant lesion. Analysis of cerebrospinal fluid (CSF) evidenced an albumin-cytologic dissociation. She was treated with corticosteroids with temporary remission of sensory symptoms and normalization of CTT. Subsequently, she developed a multineuropathy which was successfully treated with Rituximab. We discuss the potential role of anti-MAG antibodies in the pathophysiology of dorsal column impairment and the clinical usefulness of SSEPs in monitoring the evolution of anti-MAG neuropathy. MDPI 2020-05-08 /pmc/articles/PMC7287849/ /pubmed/32397154 http://dx.doi.org/10.3390/brainsci10050282 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Boscarino, Marilisa
Lanzone, Jacopo
Ricci, Lorenzo
Tombini, Mario
Di Lazzaro, Vincenzo
Assenza, Giovanni
Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title_full Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title_fullStr Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title_full_unstemmed Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title_short Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials
title_sort spinal cord impairment in anti-mag neuropathy: evidence from somatosensory evoked potentials
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287849/
https://www.ncbi.nlm.nih.gov/pubmed/32397154
http://dx.doi.org/10.3390/brainsci10050282
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