Combined acute necrotic myelopathy (ANM) and cerebellar degeneration associated with malignant disease

Clinicopathologic findings are reported in the case of an unusual combined degeneration of the cerebellum and spinal cord associated with bronchial carcinoma. Clinical features were sudden sensory onset, rapid and complete flaccid paraplegia with ascending course, sphincter paralysis, rapid impairment of general condition, and high protein content in CSF without inflammatory cell reaction. The neuropathologic findings included massive transverse necrosis at the thoracic level and degeneration of the ascending and descending tracts. The necrotic areas involved mostly white matter without any vascular topography. There was no inflammation or specific vascular alteration. In the cerebellum widespread cortical atrophy was observed. There were no metastases in the cord, meninges, vertebral column, or nerve roots. The simultaneous occurrence of two distinct types of nervous tissue alterations reflects the pathomechanisms effective in CNS reactions to extraneuronal malignancy.