Chapter 097. Paraneoplastic Neurologic Syndromes (Part 1)

Harrisons Internal Medicine Chapter 97. Paraneoplastic Neurologic SyndromesParaneoplastic Neurologic Syndromes: IntroductionParaneoplastic neurologic disorders (PNDs) are cancer-related syndromes that can affect any part of the nervous system (Table 97-1). They are remote effects of cancer, caused by mechanisms other than metastasis or by any of the complications of cancer such as coagulopathy, stroke, metabolic and nutritional conditions, infections, and side effects of cancer therapy. In 60% of patients the neurologic symptoms precede the cancer diagnosis. Overall, clinically disabling PNDs occur in 0.5–1% of all cancer patients, but they occur in 2–3% of patientswith neuroblastoma or small cell lung cancer...
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Chapter 097. Paraneoplastic Neurologic Syndromes (Part 1) Chapter 097. Paraneoplastic Neurologic Syndromes (Part 1) Harrisons Internal Medicine > Chapter 97. Paraneoplastic NeurologicSyndromes Paraneoplastic Neurologic Syndromes: Introduction Paraneoplastic neurologic disorders (PNDs) are cancer-related syndromesthat can affect any part of the nervous system (Table 97-1). They are remoteeffects of cancer, caused by mechanisms other than metastasis or by any of thecomplications of cancer such as coagulopathy, stroke, metabolic and nutritionalconditions, infections, and side effects of cancer therapy. In 60% of patients theneurologic symptoms precede the cancer diagnosis. Overall, clinically disablingPNDs occur in 0.5–1% of all cancer patients, but they occur in 2–3% of patientswith neuroblastoma or small cell lung cancer (SCLC), and in 30–50% of patientswith thymoma or sclerotic myeloma. Table 97-1 Paraneoplastic Syndromes of the Nervous System Syndromes of the brain, brainstem, and cerebellum Focal encephalitis Cortical encephalitis Limbic encephalitis Brainstem encephalitis Cerebellar dysfunction Autonomic dysfunction Paraneoplastic cerebellar degeneration Opsoclonus-myoclonusSyndromes of the spinal cord Subacute necrotizing myelopathy Motor neuron dysfunction Myelitis Stiff-person syndromeSyndromes of dorsal root ganglia Sensory neuronopathyMultiple levels of involvement Encephalomyelitis,a sensory neuronopathy, autonomic dysfunctionSyndromes of peripheral nerve Chronic and subacute sensorimotor peripheral neuropathy Vasculitis of nerve and muscle Neuropathy associated with malignant monoclonal gammopathies Peripheral nerve hyperexcitability Autonomic neuropathySyndromes of the neuromuscular junction Lambert-Eaton myasthenic syndrome Myasthenia gravisSyndromes of the muscle Polymyositis/dermatomyositis Acute necrotizing myopathy Syndromes affecting the visual system Cancer-associated retinopathy (CAR) Melanoma-associated retinopathy (MAR) Uveitis (usually in association with encephalomyelitis) a Includes cortical, limbic, or brainstem encephalitis, cerebellar dysfunction,myelitis.