Paraneoplastic/autoimmune myelopathies

Area of Science:

• Neurology
• Oncology
• Immunology

Background:

• Paraneoplastic myelopathies are rare neurological disorders affecting the spinal cord, often presenting insidiously or subacutely.
• Risk factors include tobacco use and a family history of cancer, with common neural antibodies like amphiphysin and CRMP5/anti-CV2.
• Lung and breast cancers are the most frequent oncologic associations.

Approach:

• Cerebrospinal fluid analysis typically reveals lymphocytic pleocytosis with elevated protein.
• Spinal MRI may show tract-specific, longitudinally extensive T2 hyperintensities with enhancement, though normal MRIs can occur.
• Differential diagnosis includes nutritional deficiencies and other autoimmune/inflammatory conditions like multiple sclerosis or sarcoidosis.

Key Points:

• Immune checkpoint inhibitor-induced myelitis can be considered within the spectrum of paraneoplastic myelopathies.
• Management involves addressing the underlying cancer and employing immunotherapy.
• Despite treatment, the prognosis is generally poor, with most patients becoming wheelchair-dependent.

Conclusions:

• Paraneoplastic myelopathies represent a significant neurological complication of cancer requiring multidisciplinary management.
• Understanding associated antibodies and imaging findings aids diagnosis.
• Further research into more effective treatments is warranted to improve patient outcomes.