{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:06:30Z","timestamp":1779692790681,"version":"3.53.1"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K27533"],"award-info":[{"award-number":["23K27533"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropsychopharm Rep"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although anti\u2010Zic4 antibodies are associated with paraneoplastic cerebellar degeneration, predominantly in small\u2010cell lung carcinoma, their role in postinfectious autoimmunity remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>Here, we report a 53\u2010year\u2010old woman who developed progressive cerebellar degeneration following coronavirus disease 2019 (COVID\u201019), characterized by isolated anti\u2010Zic4 antibody positivity in the absence of malignancy. Two months after developing mild respiratory symptoms, she developed dysarthria, imbalance, and gait ataxia. Neurological examination revealed gaze\u2010evoked nystagmus, broad\u2010based ataxia, and cerebellar dysmetria. Brain MRI demonstrated marked cerebellar atrophy, while cerebrospinal fluid analysis showed elevated protein, increased IgG index, and the presence of oligoclonal bands. Serological testing confirmed strong anti\u2010Zic4 antibody positivity. Initial treatment with intravenous immunoglobulin and plasmapheresis achieved transient improvement and decreased antibody titers. However, 1 year later, recurrence of antibodies coincided with further cerebellar atrophy and posterior hypoperfusion on MRI and SPECT, despite maintenance immunotherapy with low\u2010dose corticosteroids and periodic IVIG. Cognitive function was well preserved, highlighting the selective vulnerability of cerebellar circuits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates an unusual phenotype of prolonged, isolated anti\u2010Zic4 antibody\u2013associated cerebellar degeneration triggered by SARS\u2010CoV\u20102 infection, thus expanding the recognized clinical spectrum of Zic4\u2010related disorders beyond paraneoplastic contexts. The underlying immunopathological mechanisms have yet to be elucidated. Notably, radiological progression was disproportionate to clinical stabilization, underscoring the necessity of long\u2010term clinical\/imaging surveillance. This case highlights the need for further studies to clarify pathophysiological links between COVID\u201019 and persistent autoimmune cerebellar degeneration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/npr2.70094","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T11:39:42Z","timestamp":1771328382000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prolonged Anti\u2010Zic4 Antibody\u2013Positive Cerebellar Degeneration Following\n                    <scp>COVID<\/scp>\n                    \u201019 Infection"],"prefix":"10.1002","volume":"46","author":[{"given":"Risa","family":"Suzuki\u2010Yamamoto","sequence":"first","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Tokyo\u2010Kita Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6128-9029","authenticated-orcid":false,"given":"Asuka","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Furuya","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Koinuma","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuhito","family":"Fuse","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Shimo","sequence":"additional","affiliation":[{"name":"Department of Neurology Juntendo University Nerima Hospital  Tokyo 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