Complicated paraneoplastic neurological syndromes: a report of two patients with small cell or non-small cell lung cancer

• Published in: Clinical neurology and neurosurgery 2003-12, Vol.106 (1), p.47-49
• Main Authors: Hiasa, Yukiko, Kunishige, Makoto, Mitsui, Takao, Kondo, Shunsuke, Kuriwaka, Rika, Shigekiyo, Shizuka, Kanematsu, Takanori, Satake, Nobuo, Bando, Yoshimi, Kondo, Akira, Endo, Itsuro, Oshima, Yasushi, Matsumoto, Toshio
• Format: Article
• Language: English
• Subjects: Anti-Hu antibody; Ataxia; Autoantibodies - blood; Biological and medical sciences; Calcium Channels, N-Type - immunology; Cancer therapies; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - immunology; Carcinoma, Small Cell - diagnosis; Carcinoma, Small Cell - immunology; Chemotherapy; Diffusion Magnetic Resonance Imaging; Diffusion-weighted MRI; Dominance, Cerebral - physiology; ELAV Proteins; Humans; Image Enhancement; Lambert-Eaton Myasthenic Syndrome - diagnosis; Lambert-Eaton Myasthenic Syndrome - immunology; Lambert–Eaton myasthenic syndrome; Limbic Encephalitis - diagnosis; Limbic Encephalitis - immunology; Lung cancer; Lung Neoplasms; Magnetic Resonance Imaging; Male; Medical imaging; Medical sciences; Middle Aged; Nerve Tissue Proteins - immunology; Neuritis - diagnosis; Neuritis - immunology; Neurologic Examination; Neurology; Neurosurgery; Ocular Motility Disorders - diagnosis; Ocular Motility Disorders - immunology; Opsoclonus-ataxia; Paraneoplastic limbic encephalitis; Paraneoplastic Syndromes, Nervous System - diagnosis; Paraneoplastic Syndromes, Nervous System - immunology; RNA-Binding Proteins - immunology; Small cell lung cancer; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Temporal Lobe - immunology; Temporal Lobe - pathology
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/S0303-8467(03)00059-3

Paraneoplastic neurological syndromes are frequently associated in patients with small cell lung cancer (SCLC) and antineuronal antibodies are involved in the autoimmune mechanism. Multiple syndromes are sometimes complicated in a single patient with SCLC. However, little is known about non-SCLC-associated neurological manifestations. We report two patients with complicated paraneoplastic neurological syndromes. Patient 1 showed paraneoplastic limbic encephalitis (PLE), paraneoplastic sensory neuropathy (PSN) and Lambert–Eaton myasthenic syndrome (LEMS) associated with SCLC. Patient 2 developed opsoclonus-ataxia and probable PLE associated with non-SCLC. Analysis of various antineuronal antibodies revealed that anti-Hu and P/Q-type voltage-gated calcium channel (VGCC) antibodies were positive in Patient 1 but any antibodies were not in Patient 2. Brain MRI demonstrated high intensity signals in temporal lobes particularly on fluid-attenuated inversion recovery (FLAIR) or diffusion-weighted images. These findings suggest that complicated paraneoplastic neurological syndromes occur in non-SCLC as well as SCLC and that unidentified antineuronal autoantibodies may underlie the pathophysiology.