Abstract Details

Title Paraneoplastic Subacute Combined Degeneration of Spinal Cord: A Case Report in a Man with Breast Cancer

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 217

Objective

Background BACKGROUND: There are well known causes of SCD including vitamin B12, copper deficiencies and HIV infection. A paraneoplastic cause is reported in gastrointestinal cancers attributed to nutritional insufficiencies or malabsorption.

Design/Methods DESIGN/METHODS: We report a case of 75-year-old man presented with progressive legs weakness and numbness over two to three years. Hands got involved later. He lost weight. He developed right eye progressive visual loss in short period of time and was diagnosed with non-arteritic ischemic optic neuropathy. Neurologic examination showed normal mental status, poor visual acuity; in right counting fingers, in left 20/100. He had significant weakness in legs, proximally and distally. In addition, he had distal weakness in upper extremities. He had hyperreflexia, bilateral Babinski signs and absent ankle jerks. Tone was spastic. He lost vibration in toes and ankles, lost position sense at toes, and decreased pinprick sensation in legs. He had a right breast hard mass, 3 in 4 centimeters.

Results RESULTS: Studies showed normal vitamin B12, copper, Methyl Malonic Acid and Homocystiene levels. Normal CBC with MCV 92 fL. Negative Syphilis, HIV and HTLV1 serology. Immunofixation showed IgM monoclonal gammopathy. Cervical spine MRI showed longitudinal T2 hyperintensity, mainly in posterior columns, extending over several segments without enhancement. Nerve conductions and EMG showed generalized polyneuropathy with lumbosacral polyradiculopathy. Spinal fluid analysis was unremarkable. Somatosensory evoked potentials showed posterior column defects. Excision of the breast mass showed colloid carcinoma. Neurological follow up after cancer treatment revealed significant subjective and objective improvement.

Conclusions CONCLUSIONS: A paraneoplastic etiology of SCD is rare but should be considered in patients with normal studies for common causes. To our knowledge, this is first case reported in non-GI malignancies. Presence of IgM gammopathy suggests immune mediated pathogenesis.

Authors/Disclosures
PRESENTER	No disclosure on file
Shin J. Oh, MD, FAAN	No disclosure on file
Mohammad Alsharabati, MD (Advocate Medical Group)	Dr. Alsharabati has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Johnson and Johnson.
	No disclosure on file

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