Cancer and motor neuron disease-causal or coincidental? Two contrasting cases
| Autor: | John Goodfellow, Graham Mackay, Veronica Leach, George Gorrie, Sameer Patel |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Weakness Lung Neoplasms Context (language use) Breast Neoplasms Dermatology Malignancy Fasciculation 03 medical and health sciences 0302 clinical medicine Fatal Outcome medicine Humans 030212 general & internal medicine Motor Neuron Disease Denervation business.industry Carcinoma Ductal Breast Cancer General Medicine Motor neuron Middle Aged medicine.disease Small Cell Lung Carcinoma Surgery body regions Psychiatry and Mental health medicine.anatomical_structure Upper limb Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery Paraneoplastic Syndromes Nervous System |
| Zdroj: | Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 40(7) |
| ISSN: | 1590-3478 |
| Popis: | Motor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not. CASE 1: A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26 months after symptom onset. CASE 2: A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24 months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission.In cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour. |
| Databáze: | OpenAIRE |
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