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Reversible Autoimmune Encephalopathy Spectrum

Reversible Autoimmune Encephalopathy Spectrum I read with interest the article by McKeon et al1 describing 3 cases of the disease entity named in their title. The neuroimages presented in the article revealed that the first 2 cases were primarily leukoencephalopathies, thereby prompting a comparison with reversible posterior leukoencephalopathy syndrome. The entity described by McKeon and colleagues is defined primarily by its clinical and neuroimaging characteristics; reversible posterior leukoencephalopathy syndrome is similarly defined. The neuroimages in the first 2 cases could potentially be consistent with a disease process that includes demyelination in the brain. Results of an accompanying biopsy in one case and a cerebral spinal fluid examination in the other could also be reflective of a demyelinating process in the brain. Paraneoplastic leukoencephalopathies with pathologic confirmation of brain demyelination have previously been described,2-4 and reversible posterior leukoencephalopathy syndrome has been observed in patients with malignant neoplasms.5 It has previously been postulated that paraneoplastic brain demyelination and reversible posterior leukoencephalopathy syndrome are both immune mediated and are entities within a larger spectrum of immune-mediated central nervous system diseases.5 I speculate that the syndrome described by McKeon and colleagues is included in this larger spectrum. In the first paragraph of their “Comment” section, McKeon and colleagues emphasize that the disease entity named in their title is autoimmune in cause; I agree entirely. Correspondence: Dr Jaster, London Corp, 23 S Pauline St, Ste 709, Memphis, TN 38104 (harbert38104@yahoo.com). Financial Disclosure: None reported. References 1. McKeon AAhlskog JEBritton JALennon VAPittock SJ Reversible extralimbic paraneoplastic encephalopathies with large abnormalities on magnetic resonance images. Arch Neurol 2009;66 (2) 268- 271PubMedGoogle ScholarCrossref 2. Jaster JHBertorini TEDohan FC Jr et al. Solitary focal demyelination in the brain as a paraneoplastic disorder. Med Pediatr Oncol 1996;26 (2) 111- 115PubMedGoogle ScholarCrossref 3. Jaster JHNiell HBDohan FC JrSmith TW Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of leukemia and non-Hodgkin's lymphoma. Ann Hematol 2003;82 (11) 714- 715PubMedGoogle ScholarCrossref 4. Jaster JHDohan FC JrO'Brien TF Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of seminoma and central nervous system lymphoma [published correction appears in J Neurol Neurosurg Psychiatry. 2003;74(1):142]. J Neurol Neurosurg Psychiatry 2002;73 (3) 352PubMedGoogle ScholarCrossref 5. Jaster JHOttaviani GZamecnik JSmith TW Reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65 (8) 1135- 1136PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Reversible Autoimmune Encephalopathy Spectrum

Jaster, J. Howard
Archives of Neurology , Volume 66 (7) – Jul 1, 2009
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Reversible Autoimmune Encephalopathy Spectrum

Abstract

I read with interest the article by McKeon et al1 describing 3 cases of the disease entity named in their title. The neuroimages presented in the article revealed that the first 2 cases were primarily leukoencephalopathies, thereby prompting a comparison with reversible posterior leukoencephalopathy syndrome. The entity described by McKeon and colleagues is defined primarily by its clinical and neuroimaging characteristics; reversible posterior leukoencephalopathy syndrome is similarly...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneurol.2009.127
Publisher site
See Article on Publisher Site

Abstract

I read with interest the article by McKeon et al1 describing 3 cases of the disease entity named in their title. The neuroimages presented in the article revealed that the first 2 cases were primarily leukoencephalopathies, thereby prompting a comparison with reversible posterior leukoencephalopathy syndrome. The entity described by McKeon and colleagues is defined primarily by its clinical and neuroimaging characteristics; reversible posterior leukoencephalopathy syndrome is similarly defined. The neuroimages in the first 2 cases could potentially be consistent with a disease process that includes demyelination in the brain. Results of an accompanying biopsy in one case and a cerebral spinal fluid examination in the other could also be reflective of a demyelinating process in the brain. Paraneoplastic leukoencephalopathies with pathologic confirmation of brain demyelination have previously been described,2-4 and reversible posterior leukoencephalopathy syndrome has been observed in patients with malignant neoplasms.5 It has previously been postulated that paraneoplastic brain demyelination and reversible posterior leukoencephalopathy syndrome are both immune mediated and are entities within a larger spectrum of immune-mediated central nervous system diseases.5 I speculate that the syndrome described by McKeon and colleagues is included in this larger spectrum. In the first paragraph of their “Comment” section, McKeon and colleagues emphasize that the disease entity named in their title is autoimmune in cause; I agree entirely. Correspondence: Dr Jaster, London Corp, 23 S Pauline St, Ste 709, Memphis, TN 38104 (harbert38104@yahoo.com). Financial Disclosure: None reported. References 1. McKeon AAhlskog JEBritton JALennon VAPittock SJ Reversible extralimbic paraneoplastic encephalopathies with large abnormalities on magnetic resonance images. Arch Neurol 2009;66 (2) 268- 271PubMedGoogle ScholarCrossref 2. Jaster JHBertorini TEDohan FC Jr et al. Solitary focal demyelination in the brain as a paraneoplastic disorder. Med Pediatr Oncol 1996;26 (2) 111- 115PubMedGoogle ScholarCrossref 3. Jaster JHNiell HBDohan FC JrSmith TW Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of leukemia and non-Hodgkin's lymphoma. Ann Hematol 2003;82 (11) 714- 715PubMedGoogle ScholarCrossref 4. Jaster JHDohan FC JrO'Brien TF Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of seminoma and central nervous system lymphoma [published correction appears in J Neurol Neurosurg Psychiatry. 2003;74(1):142]. J Neurol Neurosurg Psychiatry 2002;73 (3) 352PubMedGoogle ScholarCrossref 5. Jaster JHOttaviani GZamecnik JSmith TW Reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65 (8) 1135- 1136PubMedGoogle ScholarCrossref

Journal

Archives of Neurology – American Medical Association

Published: Jul 1, 2009

Keywords: autoimmune encephalitis

References

  • Reversible extralimbic paraneoplastic encephalopathies with large abnormalities on magnetic resonance images.
    Pittock SJ; Arch Neurol
  • Solitary focal demyelination in the brain as a paraneoplastic disorder.
    Dohan FC; Med Pediatr Oncol
  • Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of leukemia and non-Hodgkin's lymphoma.
    Smith TW; Ann Hematol
  • Demyelination in the brain as a paraneoplastic disorder: candidates include some cases of seminoma and central nervous system lymphoma [published correction appears in J Neurol Neurosurg Psychiatry. 2003
    O'Brien TF; J Neurol Neurosurg Psychiatry
  • Reversible posterior leukoencephalopathy syndrome.
    Smith TW; Arch Neurol