The Massachusetts General Hospital Handbook of Neurology

2017-07-07 02:10:07

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

> Table of Contents > Adult Neurology > Paraneoplastic Syndromes

Paraneoplastic Syndromes

A. Incidence

Although rare (1% of cancer pts.), paraneoplastic syndromes precede the diagnosis of cancer in about 60% of cases.

Table 22. Paraneoplastic syndromes.

Syndrome	Clinical Features	Antibody	Typical Cancer
Brainstem encephalitis	Ataxia, cranial n. or motor dysfunction, abnl CSF	Ma1, Ma2	Small-cell lung cancer (SCLC), testicular
Limbic encephalitis	Depression, confusion, abnl CSF	Hu, others	SCLC
Subacute cerebellar degen.	Ataxia, dysarthria, nystagmus, nl CSF	Yo (AKA Purkinje cell)	Breast, ovary; SCLC
Opsoclonus, myoclonus	Jerky eye and limb movement	Ri	Lung, breast
Isolated CNS angiitis			Hodgkin's
Retinal degeneration	Loss of vision	Retinal	SCLC, melanoma
Spinal Cord Sx
Necrotizing myelopathy	Weakness, sensory loss	?	SCLC
Motor neuron disease	Weakness, fasciculations	?	Various lymphomas and carcinomas
Stiff person syndrome	Painful spasms	Amphiphysin, GAD	Lung, lymphoma, breast, thymoma
Peripheral Nerve Sx
Subacute sensory neurop.	Sensory ataxia, gait instability, dysesthesias	Hu, others	SCLC, plasma cell dyscrasias
Gammopathy-assoc. neurop.	Sensory loss, weakness, areflexia	Monoclonal Ig	Myeloma, Waldenstrom's, lymphoma
Guillain-Barr (AIDP)	Rapid weakness, areflexia	?	Lymphoma
Neuromuscular Junction Sx
Lambert-Eaton	Proximal weakness, areflexia, eyes spared	Calcium channel	SCLC (1%-3% of pts.)
Myasthenia gravis	Weakness, areflexia, eyes often involved	ACh receptor	Thymoma (15% of pts.)
Muscle Sx
Dermato- or polymyositis	Weakness, high CPK	Muscle	Breast, lung, GI, uterine, ovarian, Hodgkin's

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