Maimaiti Buajieerguli, Mijiti Salamaitiguli, Sun Huaiyu, Xie Yinyin, Jiang Ting, Meng Qian, Meng Hongmei
Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China.
Eur J Med Res. 2022 Apr 6;27(1):53. doi: 10.1186/s40001-022-00674-3.
Antibodies against the 65-kDa isoform of glutamic acid decarboxylase (GAD65) are biomarkers of autoimmune disorders and are more common in non-neurological autoimmune diseases than in neurological disorders. As for the central nervous system (CNS), it is well known that GAD65 is primarily associated with stiff-person syndrome, cerebellar ataxia, epilepsy, and paraneoplastic neurological syndrome. However, GAD65 antibodies have not been reported in patients with brain tumors.
This study presents the case of a 62-year-old man who manifested rapidly progressive dizziness with gradually worsening physical disturbance and unstable gait in the 2 months prior to consultation. Antibodies against GAD65 were detected in his serum. Brain magnetic resonance imaging (MRI) showed abnormal signals in the corpus callosum, the semi-oval center in both hemispheres, and the area below the frontal cortex, along with enhanced intracranial lesions in the same regions. Positron emission tomography-computed tomography (PET-CT) showed high metabolism in the corpus callosum, which protruded into both ventricles. Due to signs of malignancy, the patient was diagnosed with a malignant glioma.
This case raises awareness on the fact that anti-GAD65 antibodies may be associated with CNS neoplastic lesions. Early recognition of anti-GAD antibodies could be of great importance for the early diagnosis and targeted treatment of neoplastic lesions, and could lead to better prognosis.
抗65-kDa谷氨酸脱羧酶（GAD65）异构体抗体是自身免疫性疾病的生物标志物，在非神经自身免疫性疾病中比在神经疾病中更常见。至于中枢神经系统（CNS），众所周知，GAD65主要与僵人综合征、小脑共济失调、癫痫和副肿瘤性神经综合征相关。然而，脑肿瘤患者中尚未报道过GAD65抗体。
本研究报告了一名62岁男性的病例，该患者在就诊前2个月出现快速进展的头晕，身体不适逐渐加重，步态不稳。在他的血清中检测到了抗GAD65抗体。脑磁共振成像（MRI）显示胼胝体、双侧半球半卵圆中心和额叶皮质下方区域有异常信号，同一区域还有颅内病变强化。正电子发射断层扫描-计算机断层扫描（PET-CT）显示胼胝体有高代谢，胼胝体向双侧脑室突出。由于有恶性迹象，该患者被诊断为恶性胶质瘤。
本病例提高了人们对抗GAD65抗体可能与中枢神经系统肿瘤性病变相关这一事实的认识。早期识别抗GAD抗体对于肿瘤性病变的早期诊断和靶向治疗可能非常重要，并可能带来更好的预后。
