Acute Necrotic Myelopathy in Association with Lymphoma Cells of the Reticulo-Endothelial System, Acute Torticollis, and Recurrent Cardiac Arrest

Abstract

A case of acute necrotic myelopathy (ANM) is reported in conjunction with a noninvasive reticular type of lymphoma. The clinical course was characterized by two rare phenomena: (1) acute torticollis occurred as an initial manifestation, probably as a result of irritation of the dorsal root or dorsal horn; (2) recurrent cardiac arrest occurred late in the course, probably as a result of hypersensitivity of the sensors of postural change. The occurrence of ANM in patients with neoplasia is reviewed and it is concluded that the nature of the association is unknown. Some evidence points to abnormal immunological reactions leading to vascular damage and cord ischemia.

Paraneoplastic Subacute Necrotic Myelopathy

“…Mancall and Rosales (1964) reported the findings in two cases subacute necrotic myelopathy associated with malignancy etal. 1980;Nishida and Ziegler 1973;Richter andMoore, 1968 Sieben et al 1981;and Case 26 -1976) and our present cas indicates that males outnumbered females, in a ratio of 2 t The age of onset ranged from 16 to 79 years, the case of Grisol et al (1980), being the youngest, and the present case th oldest. The median age of onset was 56 years, with all but thre over the age of 40 years.…”

“…The protein and cell count may be norma elevated. In certain instances the albumino-cytologic dissociatio of Guillain-Barre syndrome may be mimicked (Nishida an Ziegler 1973).…”

Necrotizing myelopathy associated with malignancy. A clinicopathologic study of two cases and literature review

“…A presumptive diagnosis of carcinomatous meningitis was based on the finding of atypical cells in the cerebrospinal fluid (CSF); treatment with intrathecal MTX 15 mg was prescribed and given on April 4 and 6. A Selker subcutaneous reservoir of CSF was inserted on April 10 and further MTX treatment was given on April 12,16,19,23. and 26.…”

Acute inflammatory myelopathies

“…Subsequently, cases of otherwise unexplained necrotizing myelopathy were associated with a wide variety of malignancies, including prostate cancer (Nonne, 1903;Whiteley et al, 1979;Gray et al, 1980), lung cancer (Nonne, 1919;D'Antona, 1926;L'hermitte and Bussière de Robert, 1941;Mancall and Rosales, 1964;Ojeda, 1984;Glantz et al, 1994;Lins et al, 2003), leg sarcoma (Feindel, 1921), squamous cell skin cancer (Moersch and Kernohan, 1934), stomach cancer (Juba, 1938), thyroid cancer (Jaffe and Freeman, 1943;Kuroda et al, 1993), non-Hodgkin's lymphoma (Williams et al, 1962;Richter and Moore, 1968;Nishida and Ziegler, 1973;Whiteley et al, 1979;Gray et al, 1980;Grignani et al, 1992;Drach et al, 1996;Anderson and Borsaru, 2008), breast cancer (Mancall and Rosales, 1964;Sieben et al, 1981;Ojeda, 1984;Mueller et al, 2008), ovarian cancer (Case records of the Massachusetts General Hospital, 1976), leukemia (Reznik, 1979;Grisold et al, 1980;Gieron et al, 1987), Hodgkin's lymphoma (Lester et al, 1979;Dansey et al, 1988;Hughes et al, 1992), renal cell carcinoma (Handforth et al, 1983;Wilson et al, 1983), hepatocellular carcinoma (Misumi et al, 1988), multiple myeloma …”

“…In some cases there is involvement of the cerebellum (Renkawek and Kida, 1983;Ojeda, 1984), thalamus (Nishida and Ziegler, 1973), brainstem, mammillary bodies, and temporal lobe (Gieron et al, 1987), internal capsule (Richter and Moore, 1968), centrum semiovale (Ojeda, 1984), and parietal lobe (Whiteley et al, 1979;Gray et al, 1980). That necrosis is not restricted to the spinal cord implies that a common pathologic process afflicts multiple areas of the nervous system simultaneously.…”