Acute multifocal CNS demyelination as first presentation of systemic malignancy

Abstract

We present a patient with adenocarcinoma of the lung, without CNS metastases, who developed progressive quadreparesis like that seen in the paraneoplastic syndrome acute necrotic myelopathy.1 Pathologic examination revealed only areas of brainstem and spinal cord demyelination resembling the acute lesions of multiple sclerosis (MS). A 66-year-old man was hospitalized after 4 weeks of persistent cough and 10 days of weakness and paresthesias of the legs. Over the next 5 days, his weakness progressed to paralysis of all extremities, dysphagia, and respiratory failure. He developed bilateral Babinski signs. Cognition and vision were unaffected and the sensory examination remained normal despite paresthesias. Chest CT scan revealed a hilar mass and abnormal masses in the liver and an adrenal gland, but biopsies of the hilar mass and the liver nodule were nondiagnostic. MRI of the brain and cervical spinal cord showed increased T2 signal in the medulla, extending into the upper cervical cord and a separate focus of T2 hyperintensity in the spinal cord …