[Spinal cord paraneoplastic syndromes]

We reviewed the bibliography of various paraneoplastic syndromes which may show spinal involvement.

Paraneoplastic sensory neuropathy, myelitis and rigidity syndromes may present alone or as part of a generalized syndrome of paraneoplastic encephalomyelitis/sensory neuronopathy, usually associated with small cell cancer of the lung and anti-Hu antibodies. Amyotrophic lateral sclerosis and subacute necrotizing myelopathy of paraneoplastic origin are very rare, although casual association of these conditions with cancer cannot be ruled out. Subacute motor neuronopathy is linked to lymphoproliferative syndromes and breast cancer has been reported associated with cases of primary lateral sclerosis and the stiff man syndrome.

Various conditions of paraneoplastic origin may affect the spinal cord. Neurological symptoms may precede the diagnosis of neoplasia, are serious and do not usually respond to either immunosuppressive treatment or treatment of the underlying neoplasm, although there are exceptions. The presence of specific antibodies in some cases facilitates early diagnosis and shows the importance of immune mechanisms in these diseases. The paraneoplastic motor neuron syndromes may present atypically: at early or late age, be of slow evolution and associated with raised protein levels of the cerebrospinal fluid or with paraproteinemia.