Myelopathies in Patients With Cancer

Abstract

yelopathy is a devastating neurologic complication of cancer. The resulting pain, paralysis, and incontinence can turn a patient with cancer from a functioning individual to one who is confined to a chair or bed. Early diagnosis and appropriate therapy can prevent or ameliorate these symptoms and improve both duration of survival and quality of life. Accurate neurologic assessment of patients is crucial for early diagnosis and correct therapy. Myelopathy in patients with cancer is not rare. Epidural spinal cord compression (SCC) affects an estimated 5% of patients with cancer; other disorders such as intramedullary spinal cord metastases, adverse effects of therapy, and paraneoplastic spinal cord syndromes, although less common, are equally devastating. Because of space limitations, this review addresses the pathophysiology, clinical findings, diagnosis, and treatment of only some of the myelopathies that affect patients with cancer (Table 1). Because of new data, epidural SCC and paraneoplastic syndromes are emphasized.

MRI in transverse myelitis

“…Many patients with paraneoplastic myelopathy have identifiable autoantibodies in serum and CSF. Those which have been associated with myelopathy, often in association with encephalitis or cerebellar dysfunction, include amphiphysin antibody, antineuronal nuclear autoantibody type 2 (ANNA‐2 or anti‐Ri), ANNA‐3, collapsing response‐mediator protein 5, ANNA‐1 (anti‐Hu), Purkinje‐ell cytoplasmic autoantibody type 2 (PCA‐2), PCA‐1 (antiYo), anti‐Ma, and anti‐Ta . The malignancy is often undiagnosed at time of presentation and frequently remains occult, but the combination of the pattern of clinical involvement and autoantibody type can suggest the site of underlying cancer .…”

Paraneoplastic isolated myelopathy

“…They occur most often in the context of multifocal neurologic involvement, with encephalopathy, peripheral neuropathy, or cerebellar dysfunction, and in association with neuronal nuclear and cytoplasmic autoantibodies with the following frequencies: 24% for amphiphysin antibody 1 ; 18% for antineuronal nuclear autoantibody type 2 (ANNA-2 [anti-Ri]) 2 ; 18% for ANNA-3 3 ; 16% for collapsin response-mediator protein 5 (CRMP-5) IgG 4 ; 11%-60% for ANNA-1 (anti-Hu) 5,6 ; 10% for Purkinje-cell cytoplasmic autoantibody type 2 (PCA-2) 7 ; 5% for PCA-1 (anti-Yo) 8 ; 4% for anti-Ma 9 ; and 3% for anti-Ta. 11 Here we report the characteristics and outcome of clinically isolated paraneoplastic myelopathy. 10 The most common cancers reported are carcinomas of lung and breast.…”

"Person in the barrel" syndrome: Unusual heralding presentation of squamous cell carcinoma of the lung

“…[ 6 ] Usually, myelopathy and radiculoplexopathy associated with malignancy is compressive in nature due to spinal metastasis or immune mediated as in PNS or due to radiotherapy. [ 28 29 30 ] Recently myeloradiculopathy with similar clinical presentation of bi-brachial weakness was reported in association with testicular malignancy and anti-Ma 2 antibody. [ 21 ] In this case, we report a patient who had features of both myelopathy (loss of joint position sense, Romberg's positive along with spinal cord swelling) as well as plexopathy (weakness and sensory loss in upper limbs).…”