Ultimate Review for the Neurology Boards

Abstract

A 62-year-old woman presented with diplopia caused by bilateral sixth cranial nerve palsies. Two weeks later, she had bulbar weakness and ataxia. Brain magnetic resonance imaging showed non-specific abnormalities and spinal fluid was acellular but contained an elevated protein and oligoclonal bands. A paraneoplastic screen showed anti-Hu antibodies. Her clinical condition improved with immunoglobulin and systemic corticosteroid treatment. Breast cancer was diagnosed 21 months later by mammography but there were no metastases detected. Four and half years after the onset of her diplopia, she died of diffuse metastatic breast cancer. This is the first reported case of anti-Hu paraneoplastic brain stem encephalitis presenting with sixth cranial nerve palsies.

Lung cancer-induced paraneoplastic syndromes

“…The clinical manifestation of the syndrome can be varied; the presentation may include limbic encephalitis, brainstem encephalitis, opsoclonus-myoclonus, cerebellar degeneration, myelopathy, cranial nerve palsy [60], and sensory neuropathy [61]. Limbic encephalitis usually presents with rapidly progressive short-term memory deficits, psychiatric symptoms, and seizures.…”

Clinical and Organizational Factors in the Initial Evaluation of Patients With Lung Cancer

“…90% of cases of paraneoplastic anti-Hu syndrome. The clinical manifestation may include limbic encephalitis, brainstem encephalitis, cerebellar degeneration, opsoclonus myoclonus, myelopathy, cranial nerve palsy, 97 and sensory neuropathy. 98 Limbic encephalitis usually presents with rapidly progressive loss of short-term memory, seizures, and 3.1.4 Carcinoid Syndrome: Bronchopulmonary neuroendocrine tumors (NETs) comprise about 20% of all lung neoplasms.…”