Clinical characteristics of patients with paraneoplastic myelopathy

• Published in: Journal of neuroimmunology 2019-05, Vol.330, p.136-142
• Main Authors: Liu, Zheng, Jiao, Lidong, Qiu, Zhandong, Da, Yuwei, Tang, Yi, Lin, Yicong, Li, Dawei, Huang, Jing, Kang, Xiong, Dong, Huiqing
• Format: Article
• Language: English
• Subjects: Autoimmune; Myelopathy; Paraneoplastic; Spinal cord
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2019.03.001

Paraneoplastic myelopathy is rare paraneoplastic neurological syndromes. We reviewed patients through medical records system and screened patients who presented with myelopathy, and/or coexisting cancer, and/or onconeural antibodies. Nine patients were identified as paraneoplastic myelopathy presenting with progressive subacute (2/9) or insidious (7/9) myelopathy. CSF abnormalities included elevated protein, 5; pleocytosis, 4; excess oligoclonal bands, 6. Seven patients had onconeural antibody. Cancer was confirmed histopathologically in 6 and diagnosed by PET-CT in 1. Four patients had symmetric, longitudinally extensive grey matter or tract-specific changes on spinal cord MRI. It was associated with significant morbidity and had poor response to treatment. Spinal cord MRI from patient 1(A1–6) and patient 8 (D1–3) with paraneoplastic myelopathy. Patient 1 had longitudinally extensive T2 signal abnormality extending across 18 spinal segments (A1, A2) that symmetrically involved the central grey matter on axial T2-weighted images (A3, A4, A5, A6). Patient 8 had tract-specific T2 signal abnormality on the sagittal section extending across 4 segments from T8 to T11 (D1) with symmetric involvement of the lateral columns (D2, D3). [Display omitted] •Paraneoplastic myelopathy is rare paraneoplastic syndromes and presents with myelopathy of insidious or subacute onset.•Paraneoplastic myelopathy usually precedes cancer detection.•Paraneoplastic myelopathy has autoimmune characteristics with CSF pleocytosis or ologoclonal bands in early stage.•Nearly half of patients have symmetric, longitudinally extensive grey matter or tract-specific changes on spinal cord MRI.•Paraneoplastic myelopathy is associated with significant morbidity and poor response to therapy.