Abstract

Paraneoplastic syndromes are systemic reactions to neoplasms mediated by immunologic or hormonal mechanisms. The most well-recognized paraneoplastic neurologic syndrome, both clinically and on imaging, is limbic encephalitis. However, numerous additional clinically described syndromes affect the brain, spinal cord, and peripheral nerves. Many of these syndromes can have imaging findings that, though less well described, are important in making the correct diagnosis. Moreover, imaging in these syndromes frequently mimics more common pathology, which can be a diagnostic challenge for radiologists. Our goal is to review the imaging findings of paraneoplastic neurologic syndromes, including less well-known entities and atypical presentations of common entities. Specifically, we discuss limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic brain stem encephalitis, cranial neuropathy, myelitis, and polyneuropathy. We also demonstrate common diagnostic pitfalls that can be encountered when imaging these patients.

Highlights

  • The patients presented were diagnosed with paraneoplastic syndromes based on a combination of clinical, laboratory, and imaging findings

  • Paraneoplastic neurologic syndromes can cause a wide range of imaging abnormalities throughout the central and peripheral nervous systems

  • Prior reports have focused on the imaging findings of limbic encephalitis, but as we have shown, Paraneoplastic syndromes (PNSs) involving other parts of the nervous system can have characteristic imaging findings

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Summary

Introduction

The patients presented were diagnosed with paraneoplastic syndromes based on a combination of clinical, laboratory, and imaging findings. Typical imaging findings of limbic encephalitis include T2 hyperintensity and swelling of the mesial temporal lobes with FDG avidity on PET (Fig 2A, -B), sometimes with associated enhancement.

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