Dorsal cauda equina nerve root enhancement on magnetic resonance imaging due to ANNA-1-associated paraneoplastic polyneuropathy

A 69-year-old female presented with subacute onset ascending weakness and paraesthesias. She was initially diagnosed with Guillain–Barré syndrome (GBS) based on her clinical presentation and cerebrospinal fluid (CSF) analysis showing albuminocytological dissociation. However, she was later found to have anti-neuronal nuclear antibody 1 (ANNA-1/anti-Hu)-positive CSF and was subsequently diagnosed with small-cell lung cancer. Her neurological symptoms were ultimately attributed to ANNA-1/anti-Hu-associated paraneoplastic polyneuropathy. During the course of her evaluation, she had magnetic resonance imaging findings of dorsal predominant cauda equina nerve root enhancement, which has not been previously described. The only previously reported case of cauda equina enhancement due to ANNA-1-associated polyneuropathy described ventral predominant findings. The distinction between ventral and dorsal enhancement is important, since it suggests that different patterns of nerve root involvement may be associated with this paraneoplastic syndrome. Therefore, ANNA-1-associated paraneoplastic inflammatory polyneuropathy can be considered in the differential diagnosis of cauda equina nerve root enhancement with ventral and/or dorsal predominance. This can potentially be helpful in differentiating ANNA-1 polyneuropathy from GBS, which classically has ventral predominant enhancement.

Paraneoplastic polyneuropathy associated with ovarian cancer

Clinical observation of a patient with a paraneoplastic polyneuropathy, associated with ovarian cancer, is presented. A feature of this case is its relative rarity. Stages of development of neurological disorders in combination with laboratory diagnostics data led to the need for oncological search, which resulted in the detection of ovarian cancer. Te histological diagnosis is confrmed by immunohistochemical method. Malignant tumor was detected one year afer the appearance of the frst signs of sensory polyneuropathy, which confrms the paraneoplastic nature of neurological disorders. A timely treatment for a malignant tumor can lead to the stabilization of neurological symptoms.

RARE PARANEOPLASTIC POLYNEUROPATHY SECONDARY TO SKIN MELANOMA

Paraneoplastic diseases of peripheral and central nervous systems are rare manifestations of malignancies. Here we report a rare case of 51 year old male who presented with symmetrical progressive sensory and motor deficit over the course of one year. His past medical history included a malignant melanoma excised 5 years ago from the skin of interscapular region.His nerve conduction studies showed evidence of severe, symmetrical, predominantly sensory, axonal peripheral neuropathy. He under-went CT chest-abdomen-pelvis which showed large right axillary lymph nodes. Axillary Lymph node biopsy contained metastatic melanoma cells positive with MelanA and HMB 45. Analysis of the BRAF gene from biopsy sample cells revealed the presence of a mutation within codon 600 of the BRAF gene. All further investigations did not show evidence of any other type of tumour.Paraneoplastic syndromes can affect the motor, sensory and autonomic nervous systems and are associated with lung cancer, especially small-cell lung cancer, lymphoma and gynecological tumors. To our knowledge our case is the first report of paraneoplastic polyneuropathy secondary to malignant melanoma.The presence of paraneoplastic neuropathy should be considered in all patients with malignancy and can happen at any point in the disease prior or after induction of any treatment. We report rare case of malignant melanoma presenting with paraneoplastic polyneuropathy.

Endometrial Carcinoma Presenting as Vasculitic Sensorimotor Polyneuropathy

Paraneoplastic syndromes (PNS) are a heterogeneous group of symptoms which are indirectly caused by primary or metastatic tumor. Paraneoplastic polyneuropathy (PNP) is mostly related to small cell lung cancer (5%), prostate, gastric, and breast cancer. Only sporadic cases have been reported to be associated with endometrial cancer. We present a case of a premenopausal woman with severe vasculitic, asymmetric sensorimotor polyneuropathy that developed in conjunction with an endometrial carcinoma responding to surgical therapy of primary tumor combined to steroid therapy. Neurological symptoms such as asymmetrical sensorimotor deficits and painful paresthesias are suspicious when they occur in otherwise healthy women with no medical history. The phenomenon of a paraneoplastic syndrome can point to an underlying malignancy and can be used as marker of progression or regression of the tumor. Due to the rarity of PNP, there is no standard treatment. Recommended therapy is stage-adjusted treatment of the primary tumor.

Peripheral neuropathy in a cat with renal lymphoma

A 12-year-old male cat was referred for progressive limb weakness lasting 2 weeks. Physical examination detected muscle atrophy and bilateral renomegaly with distortion of the renal contours. The cat was ambulatory but tetraparetic. It showed a peculiar posture on forelimbs with bilateral flexion of the carpi and extrarotation of forearms. The cat was unable to go upstairs or jump. Neurological examination showed findings compatible with peripheral nervous system involvement. Histopathological findings revealed a high grade non-B, non-T cell renal lymphoma and peripheral neuropathy characterised by demyelination, axonal degeneration and muscle denervation. In the absence of congenital, metabolic and infectious diseases or exposure to toxins, a paraneoplastic peripheral neuropathy was hypothesised. In humans and dogs, paraneoplastic peripheral neuropathies have been documented with different neoplastic processes including lymphoproliferative disorders. To the authors' knowledge, this is the first report of suspected paraneoplastic polyneuropathy in a cat with malignant tumour.