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[A case of anti-gliadin-antibody-positive cerebellar ataxia effectively treated with intravenous immunoglobulin in which voxel-based morphometry and FineSRT were diagnostically useful].

Abstract
We present the case of a 51-year-old man with a 5-year history of slowly progressive gait ataxia and dysarthria who showed a wide-based gait requiring assistance. The patient's score on the Revised Hasegawa Dementia Scale (HDS-R) was 22/30 and constructional apraxia was also evident. Cerebrospinal fluid analysis showed 3 cells/microl, and the protein concentration was 58 mg/dl. Brain MRI showed no evidence of cerebellar atrophy, and SPECT-eZIS showed no decrease in cerebellar blood flow. However, voxel based morphometry (VBM) and FineSRT revealed cortical cerebellar atrophy and reduced cerebellar blood flow. In addition, the patient tested positive for anti-gliadin (IgA) and anti-SS-A/Ro antibodies, and was thus diagnosed as having autoimmune cerebellar ataxia. The patient showed positive response to intravenous immunoglobulins (IVIg) and regained the ability to walk unassisted. The HDS-R score also improved to 27/30. If cortical cerebellar atrophy can be diagnosed in the early stages in patients with progressive cerebellar ataxia by imaging techniques such as MRI-VBM and FineSRT, and if such patients test positive for anti-gliadin, anti-GAD or anti-thyroid antibodies, it is possible that they have autoimmune cerebellar ataxia. The commencement of immunotherapy including IVIg should be considered in such
AuthorsKazunori Nanri, Takao Otsuka, Masafumi Takeguchi, Takeshi Taguchi, Tomoko Ishiko, Hiroshi Mitoma, Kiyoshi Koizumi
JournalRinsho shinkeigaku = Clinical neurology (Rinsho Shinkeigaku) Vol. 49 Issue 1 Pg. 37-42 (Jan 2009) ISSN: 0009-918X [Print] Japan
PMID19227895 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Autoantibodies
  • Immunoglobulins, Intravenous
  • Gliadin
Topics
  • Autoantibodies (analysis)
  • Autoimmune Diseases (diagnosis, drug therapy, immunology)
  • Cerebellar Ataxia (diagnosis, drug therapy, immunology)
  • Gliadin (immunology)
  • Humans
  • Immunoglobulins, Intravenous (therapeutic use)
  • Male
  • Middle Aged
  • Organ Size
  • Software

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