ABSTRACT
Though raised titres of voltage gated potassium channel (VGKC) complex antibodies have been occasionally associated with extracranial tumours, mainly presenting as Morvan's Syndrome or neuromyotonia, they have not yet been reported to be associated with an intracranial malignancy. This is especially important as misdiagnosis of these conditions and delay of the appropriate treatment can have important prognostic implications. We describe a patient with a high grade glioma presenting with clinical, radiological, and serological features consistent with the diagnosis of VGKC antibody associated limbic encephalitis (LE). This is the first association between a primary brain tumour and high titre of VGKC complex antibodies. Clinicoradiological progression despite effective immunosuppressive treatment should prompt clinicians to look for alternative diagnoses. Further studies to elucidate a possible association between VGKC complex and other surface antigen antibodies with primary brain tumours should be carried out.
ABSTRACT
Introducción. La metamorfopsia invertida es un trastorno de la percepción visuoespacial de los objetos, sin alteración de su forma, tamaño o color. Generalmente se trata de una rotación completa de 180° del campo visual en el plano coronal. Su principal etiología es la isquemia vertebrobasilar, aunque se han relacionado otras muchas entidades con este fenó- meno, como la esclerosis múltiple, la epilepsia, la migraña o los traumatismos craneocervicales. Algunas características destacables de la metamorfopsia invertida son la gran variedad topográfica de las lesiones responsables del fenómeno, el carácter transitorio del síntoma y su mejoría o resolución ante determinados estímulos. Caso clínico. Varón de 35 años con un episodio brusco de inestabilidad que le impedía la marcha, acompañado de vómitos y metamorfopsia invertida de una hora de duración. Mediante resonancia se identificó una lesión cerebelosa isquémica aguda como responsable del cuadro. Conclusiones. La variedad topográfica de las lesiones que ocasionan una metamorfopsia invertida se debería principalmente al carácter multisensorial de las neuronas de la corteza parietal posterior, el área del cerebro donde se realiza la integración visuoespacial de las imágenes. Estas neuronas reciben aferencias visuales, propioceptivas y vestibulares, por lo que cualquier lesión de estos tres sistemas o en la propia área de integración sería capaz de provocar el fenómeno de la metamorfopsia invertida (AU)
Introduction. Reversal of vision metamorphopsia is a disorder affecting the visuospatial perception of objects, without any changes in their shape, size or colour. It generally involves a full 180º rotation of the visual field in the coronal plane. Its chief causation is vertebrobasilar ischaemia, although the phenomenon has also been linked to many other conditions, such as multiple sclerosis, epilepsy, migraine or traumatic head and neck injuries. Some notable features of reversal of vision metamorphopsia are the wide topographic variety of the lesions responsible for the condition, the transient nature of the symptom and its improvement or resolution in the presence of certain stimuli. Case report. A 35-year-old male with a sudden episode of instability that prevented him from walking, together with vomiting and reversal of vision metamorphopsia that lasted for an hour. A magnetic resonance scan enabled us to identify an acute ischaemic cerebellar lesion as the cause of the condition. Conclusions. The variety of locations of the lesions that give rise to reversal of vision metamorphopsia would be mainly due to the multisensory nature of the neurons in the posterior parietal cortex, the area of the brain where the visuospatial integration of images is performed. These neurons receive visual, proprioceptive and vestibular afferences, which means that any lesions that occur in these three systems or in the central integrator itself could cause the phenomenon of reversal of vision metamorphopsia (AU)
