Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Paraneoplastic Myelopathy
KEY FACTS
Terminology
-
Paraneoplastic neurologic disorder
-
Antineuronal immune mechanism targeting CNS, occurring in conjunction with cancer
Imaging
-
Longitudinally extensive, symmetric, tract-specific signal changes within spinal cord that often enhance after gadolinium administration in patient with cancer
-
Signal abnormality in ~ 70% of cases
-
Lateral, dorsal columns
-
Central gray matter
Top Differential Diagnoses
-
Cord infarction
-
Neuromyelitis optica
-
B12 deficiency (subacute combined degeneration)
-
Metastatic disease
-
Neurosarcoidosis
Pathology
-
Paraneoplastic disease usually
-
Antibodies against intracellular antigens
-
Older individuals, resistant to treatment
-
Mediated by T-cell mechanisms
-
-
Most common with lung and breast cancer
-
Most common antibodies causing myelopathy
-
Amphiphysin-IgG
-
Collapsin response-mediator protein-5
-
Clinical Issues
-
Insidiously progressive myelopathy
-
Often manifesting before detection of underlying cancer (2/3 of patients)
-
Median of 12 months from myelopathy onset to cancer detection
-
-
Poor prognosis, often becoming wheelchair dependent
Sagittal T1 MR shows multiple metastatic lesions
involving the cervical and upper thoracic vertebral bodies, with marrow conversion from prior radiation therapy
. The cord is mildly expanded.
involving the cervical and upper thoracic vertebral bodies, with marrow conversion from prior radiation therapy . The cord is mildly expanded.
Sagittal T2 MR in the same patient shows longitudinally extensive high signal within the cervical cord, with mild cord expansion
. This edema pattern is nonspecific, and cord metastases and radiation change should also be considered.
. This edema pattern is nonspecific, and cord metastases and radiation change should also be considered.
Axial T1 C+ MR in the same patient shows the typical pattern of paraneoplastic myelopathy with focal central tract enhancement
in a symmetrical fashion. This symmetrical tract involvement would not be seen with metastases or radiation change.
in a symmetrical fashion. This symmetrical tract involvement would not be seen with metastases or radiation change.
Sagittal T1 C+ MR in a patient with a focal cord metastasis
shows the very localized nature of the tumor to be contrasted, with the longitudinally extensive abnormality with paraneoplastic disease of the cord.
shows the very localized nature of the tumor to be contrasted, with the longitudinally extensive abnormality with paraneoplastic disease of the cord.
TERMINOLOGY
Abbreviations
-
Paraneoplastic neurologic disorder (PND)
Definitions
-
Antineuronal immune mechanism targeting CNS, occurring in conjunction with cancer
IMAGING
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here