Describe a case of a young female with subacute onset of paraneoplastic spastic paraparesis as the heralding symptom of nodular sclerosing lymphoma.

Paraneoplastic syndromes are an increasingly described phenomena, often neurologic in presentation, associated with many different malignancies.  In this case report, we describe what we believe to be the first description of a paraneoplastic spastic paraparesis associated with noduler sclerosing lymphoma. 

Clinical findings are presented in a novel presentation of paraneoplastic spastic paraparesis as the initial feature of lymphoma.

The patient presented as a 24 year old female complaining of falls with initial symptoms of painful dystonic posturing of her toes occurring in the morning followed by frequent falls associated with clonic movements of her right foot, an abnormal gait, non-specific pelvic pain and eventual difficulty voiding.  Her neurologic examination was notable for asymmetric spastic hyperreflexia of the lower extremities with sustained clonus, minimal hip flexor weakness and a spastic gait which progressed over the next five months to the point of requiring assistive devices to ambulate with intermittent self-catheter use for voiding. She did not develop craniobulbar or upper extremity symptoms.

The majority of her work up was unremarkable to include serum and CSF labs along with CNS imaging.  Thorough evaluation revealed only FDG-PET avid mediastinal and supraclavicular lymph nodes which were subsequently resected and provided a diagnosis of nodular sclerosing lymphoma.  Significant improvement in her gait after lymph node resection was noted with complete resolution of her symptoms after chemotherapy and successful treatment of her lymphoma.

To our knowledge, this case demonstrates a novel presentation of paraneoplastic syndrome as an isolated spastic parapresis in this specific type of lymphoma.  This is crucial in acknowledging when building a differential diagnosis for this presentation given its potential for diagnosis and curative therapy.