title: Complicated paraneoplastic neurological syndromes: a report of two patients with small cell or non-small cell lung cancer.
abstract: 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.
authors.affiliation: First Department of Internal Medicine, University of Tokushima School of Medicine, 3 Kuramoto-cho, Tokushima city, Tokushima 770-8503, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Makoto
authors.initials: M
authors.lastname: Kunishige
authors.forename: Takao
authors.initials: T
authors.lastname: Mitsui
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kondo
authors.forename: Rika
authors.initials: R
authors.lastname: Kuriwaka
authors.forename: Shizuka
authors.initials: S
authors.lastname: Shigekiyo
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanematsu
authors.forename: Nobuo
authors.initials: N
authors.lastname: Satake
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Bando
authors.forename: Akira
authors.initials: A
authors.lastname: Kondo
authors.forename: Itsuro
authors.initials: I
authors.lastname: Endo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D020864:Calcium Channels, N-Type; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins; D016601:RNA-Binding Proteins