paraneoplastic myelopathy
Introduction
Introduction to paraneoplastic myelopathy The distant effects of the tumor can cause damage to the spinal cord. The spinal cord lesions have different manifestations due to their different clinical types. Necrotizing myelopathy, myelitis, and subacute motor neuron disease can all be clinical manifestations of spinal cord damage in paraneoplastic syndrome. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: dementia
Cause
Cause of paraneoplastic myelopathy
Cause:
It is unclear that the current trend toward paraneoplastic spinal cord lesions is an autoimmune response caused by systemic or potential tumors.
Pathogenesis
The current pathogenesis is still unclear, but it is generally believed to be related to autoimmunity. It has been reported in the literature that anti-Hu antibodies (anti-neuron antibodies) are associated with paraneoplastic encephalomyelitis.
Prevention
Paraneoplastic myelopathy prevention
1. Reasonable meal
Choose healthy foods and beverages instead of high-fat, high-sugar and high-calorie foods, eat different types of vegetables, fruits, whole grains and legumes, reduce the consumption of red meat (beef, pork and lamb), and avoid processed meat. Class, limit the consumption of high-salt foods.
2, limit drinking
For cancer prevention, try not to drink alcohol. If you drink alcohol, you should limit your daily alcohol consumption. Men should not be more than 2 cups per day, and women should not be more than 1 cup.
3, balance mentality, mental health
Mental health is a good medicine to overcome the disease, and bad mood may be a cancer-promoting agent.
Complication
Paraneoplastic myelopathy complications Complications dementia
Paraneoplastic damage, such as involving the nervous system in other parts of the body, can also cause language difficulties, dementia, memory impairment, pyramidal tract disease or other neuropathy, can also affect many tissues and organs in the body, resulting in corresponding clinical manifestations, such as joints Inflammation, rash, endocrine dysfunction, etc.
Symptom
Symptoms of paraneoplastic myelopathy common symptoms sensory disturbance paraplegia spinal cord compression back pain
The two main clinical types of paraneoplastic myelopathy are as follows:
1. Necrotic myelopathy: There is no specific type of primary tumor disease in this disease, but it is easy to occur in lung cancer, followed by lymphoma, prostate cancer, thyroid cancer, breast cancer, calf giant cell sarcoma, cutaneous squamous cell carcinoma and Renal cell carcinoma, although there are many types of cancer, is very similar in clinical manifestations.
The course of the disease is subacute onset, and gradually develops into complete transverse spinal cord injury. The first clinical symptom of the patient is asymmetrical lower limb weakness. The clinical symptoms may be paraplegia, incontinence, and sensory disturbance, but no pain occurs. The plane that is damaged during the course of the disease can continuously rise, and it will die due to affecting the respiratory muscle within a few days or weeks. The neurological examination can be seen with a damaged sensory plane. The thoracic injury is more common, and there are soft limbs of the extremities. Clinical Symptoms are not consistent with the course of the tumor and can occur before the tumor is discovered or during the tumor remission period.
CSF examination revealed increased mononuclear cells and protein. Spinal cord angiography or MRI showed swelling of the spinal cord in the segment of the lesion. Pathological examination showed that the damaged stage showed transverse large necrosis. Some people thought that the gray matter, myelin and axon mainly involved in the spinal cord. Injury, inflammatory reactions rarely occur, and there are reports in the literature that lesions involving the white matter of the spinal cord are more obvious than gray matter and blood vessels.
The disease usually does not have back pain or spine soreness, which can be differentiated from spinal cord compression caused by epidural metastasis of more common malignant tumors; and because the symptoms of the disease are symmetrical, and the plane of spinal cord damage is rapid Rise, no history of radiation therapy, so it can be differentiated from radiation-induced myelopathy.
2. Subacute motor neuron disease: The pathogenesis of this disease is unknown. Some people think that it may be a long-term use of immunosuppressive agents in tumor patients, resulting in a lower immunity of the body and secondary infection of the virus. The lesion resembles "polio". However, the poliovirus cannot be isolated. Because the disease is closely related to lymphoma, it is considered to be a type of paraneoplastic syndrome.
The disease is late onset, and it usually develops after 40 to 50 years old. The course of disease is longer and the progress is slow. The progress of the disease is not consistent with the progress of the tumor. It is accompanied by Hodgkin's disease or other malignant lymphoma. After the diagnosis of malignant tumors, and often the symptoms of nervous system damage during tumor remission, the main clinical manifestations are subacute progressive lower extremity weakness, without pain, upper limb involvement is generally mild, the symptoms of this disease It is limited to the extent of damage to the lower motor neurons, and there is no manifestation of nucleus involvement in the brain. The electromyogram shows denervation potential, exercise, and sensory conduction velocity are basically normal. Some patients may have mild paresthesia, CSF examination. There may be mild protein-cell separation, the number of cells is basically normal, and there is no specific treatment for subacute motor neuron disease.
The pathological changes of the disease are the loss of the anterior horn cells of the spinal cord, degenerative changes, and the flaky demyelination changes in the white matter of the spinal cord. The posterior cord lesions of the spinal cord are more obvious, and there is generally no inflammatory reaction in the spinal cord. There are no lesions in the lateral cord.
Examine
Examination of paraneoplastic myelopathy
1. Serum and CSF immunological specific antibody examination.
2. Regular examination of hematuria.
3. The nervous system CT, MRI examination, has the significance of localization diagnosis.
4. Neuromuscular electrophysiological examination.
Diagnosis
Diagnosis and diagnosis of paraneoplastic myelopathy
Mainly based on the patient's clinical manifestations and related antibody tests, no primary tumors were easily misdiagnosed.
It is especially important for patients who are experiencing clinical symptoms of persistent neurological symptoms to be alert to this syndrome.
Systemic examination did not find cancer, need to be reviewed regularly, cerebrospinal fluid and electrophysiological examination is helpful for diagnosis, serum or CSF-specific autoantibodies can confirm PNS and suggest potential tumor properties.
Pay attention to the identification of primary diseases of the nervous system.
