Paraneoplastic Subacute Necrotic Myelopathy

Abstract

SUMMARY:A 79 year old male acutely developed a Brown-Sequard syndrome two weeks following resection of renal cell carcinoma. The subsequent clinical course was marked by subacute progression of spinal cord signs. Pathologic studies showed extensive multifocal spinal cord necrosis that could not be attributed to vascular occlusion or to vasculitis. This case appears to be a rare example of paraneoplastic subacute necrotic myelopathy.

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 …”

Paraneoplastic syndromes of the spinal cord, nerve, and muscle

“…146 In a few instances, additional involvement of the optic nerves, chiasm, internal capsule, brainstem, and cerebellum has been identified. 88,119,193 The blood vessels may show adventitial thickening and fibrosis, or frank necrosis, but vascular occlusion is rare. Inflammatory infiltrates are minimal or absent.…”