Paraneoplastic Neurological Disorder
What is this condition?
Paraneoplastic neurological disorder (PND - unofficial abbreviation) is type of paraneoplastic-syndrome that involves the nervous system. It is a rare neurological condition however identifying this condition is important as it indicates an underlying serious pathology in the form of a tumor somewhere in the body.
What are paraneoplastic syndromes?
They are defined as those syndromes or health conditions that are the result of a distant (or remote) effect of a tumor. It is required that to fulfill this diagnosis such distant effects must not be cased by the spread of the tumor (metastasis), any infections, metabolic derangements, or compromise in the circulation (ischemia) etc.
Examples of some PND include;
• Limbic encephalitis
• LEMS (Lambert-Eaton myasthenia syndrome)
• Peripheral neuropathies
• Opsoclonus-myoclonus syndrome
• Retinal damage & blindness
• Cerebellar degeneration
• Cortical brain degeneration
• Dermatomyositis/ Polymyositis etc.
Such paraneoplastic disorders occur out side the nervous system too.
Some common tumors that are associated with PND include;
• Lung cancer (small cell type)
• Breast cancer
• Testicular tumor
• Ovarian tumors
• Gastrointestinal tumors etc.
How does the patient present?
The clinical manifestation will depend upon what part of the nervous system is affected with PND. Some of the examples include;
• Progressive skeletal muscle weakness
• Fatigable type of muscle weakness
• Blurring of vision/blindness
• Gait ataxia
• Altered sensorium/confusion
• Seizures etc.
The diagnosis of this condition may require several investigations depending upon the type we are suspecting. A strong clinical suspicion is necessary since these disorders are not that common so easily overlooked. Depending upon the exact tumor and the syndrome we are suspecting several special blood tests, CT or MRI scans, EMG/Nerve conduction study etc may be needed to arrive at a precise diagnosis.
The management will depend upon the primary tumor and the PND type patient is having. Symptomatic treatments are tried to control the symptoms patient is having and specific treatments like radiotherapy or chemotherapy etc may be needed to control the tumor itself.
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