Abstract Details

Title Paraneoplastic Mononeuropathy Multiplex in a Patient with Primary Ovarian Cancer and Papillary Thyroid Cancer

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 069

Objective To describe a patient with paraneoplastic mononeuropathy multiplex (MNM) associated with ovarian and papillary thyroid cancer.

Background MNM is typically associated with vasculitis. It rarely presents as a paraneoplastic disorder, commonly with neoplasms of the lung.

Design/Methods

Results A 65-year-old woman with no significant past medical history presented with progressive subacute weakness, numbness, and pain in both arms for 2.5 months. Neurological examination showed bilateral arm weakness, decreased sensation, and diminished reflexes in multiple nerve distributions. No upper motor neuron signs were seen. Serum tests showed elevated ESR at 92, positive ANA at 1:2560, elevated neurofilament light chain (NfL) at 2011, and elevated CA125 at 176.3. CSF studies were normal. Brain MRI showed corticospinal tract hyperintensity on DWI and FLAIR sequences. EMG/NCS showed findings consistent with MNM. Muscle and nerve biopsies were suggestive of a vascular or immune etiology. CT of the chest, abdomen, and pelvis was normal. PET scan showed increased uptake in the right ovary and omentum. Supraclavicular lymph node biopsy was suggestive of primary ovarian cancer and papillary thyroid cancer. Serum paraneoplastic panels were negative. The patient was treated with IVIG, IV methylprednisolone, and IV cyclophosphamide with minimal improvement of her symptoms. She then underwent chemotherapy with carboplatin and taxol, and tumor debulking surgery. At 3-month follow-up, she showed a slight improvement in her strength, and NfL and CA 125 levels were decreased.

Conclusions MNM may present as a paraneoplastic disorder with ovarian and papillary thyroid cancer. Corticospinal tract hyperintensity may be seen in paraneoplastic disorders. CT screening alone may not detect the neoplasm. In suspected malignancy, PET scan should be performed.

Authors/Disclosures
Busranur Agac, MD (National Institutes of Health) PRESENTER	Dr. Agac has nothing to disclose.
Christopher D. Alexander, MD (Washington University in St Louis, Department of Neurology)	Dr. Alexander has nothing to disclose.
Muhammad Al-Lozi, MD (Washington University in Saint Louis)	Dr. Al-Lozi has nothing to disclose.

��ɫ��

��ɫ��