Complicated paraneoplastic neurological syndromes: a report of two patients with small cell or non-small cell lung cancer.
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.
Hiasa
Yukiko
Y
First Department of Internal Medicine, University of Tokushima School of Medicine, 3 Kuramoto-cho, Tokushima city, Tokushima 770-8503, Japan.
Kunishige
Makoto
M
Mitsui
Takao
T
Kondo
Shunsuke
S
Kuriwaka
Rika
R
Shigekiyo
Shizuka
S
Kanematsu
Takanori
T
Satake
Nobuo
N
Bando
Yoshimi
Y
Kondo
Akira
A
Endo
Itsuro
I
Oshima
Yasushi
Y
Matsumoto
Toshio
T
D001323:Autoantibodies / Q000097:blood; D020864:Calcium Channels, N-Type / Q000276:immunology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000276:immunology; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000276:immunology; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D051959:ELAV Proteins; D006801:Humans; D007089:Image Enhancement; D015624:Lambert-Eaton Myasthenic Syndrome / Q000175:diagnosis* / Q000276:immunology; D020363:Limbic Encephalitis / Q000175:diagnosis* / Q000276:immunology; D008175:Lung Neoplasms; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000276:immunology; D009443:Neuritis / Q000175:diagnosis* / Q000276:immunology; D009460:Neurologic Examination; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000276:immunology; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis* / Q000276:immunology; D016601:RNA-Binding Proteins / Q000276:immunology; D013702:Temporal Lobe / Q000276:immunology / Q000473:pathology
D001323:Autoantibodies; D020864:Calcium Channels, N-Type; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins; D016601:RNA-Binding Proteins