Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Anti-amphiphysin antibody-positive paraneoplastic neurological syndrome with a longitudinally extensive spinal cord lesion of the dorsal column

Shuichiro Neshige, M.D.1), Naoyuki Hara, M.D.1)2), Shinichi Takeshima, M.D.1), Hirotaka Iwaki, M.D.1)3), Yutaka Shimoe, M.D.1), Kazuhiro Takamatsu, M.D.1) and Masaru Kuriyama, M.D., Ph.D.1)

1)Department of Neurology, Brain Attack Center Ota Memorial Hospital
2)Present address: Department of Neurology, Hiroshima City Hospital
3)Present address: Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine

A 53-year-old woman was admitted to our hospital because of gait disturbance and paresthesia of the lower extremities. She also had marked deep sense impairment in her lower limbs. Cervical MRI showed a longitudinally extensive spinal cord lesion of the dorsal column at levels C1 T11. The findings of cerebrospinal fluid examination, including the IgG index (0.65), were normal. Serum anti-AQP4 antibody was negative, but anti-amphiphysin antibody was positive. Electrophysiological examinations suggested the presence of lesions in the dorsal column of the spinal cord and dorsal root ganglion (DRG). Enlargement of and fluorodeoxyglucose accumulation in her left parasternal lymph node was observed on contrast-enhanced CT and PET-CT, respectively. The lymph node biopsy was underwent by using thoracoscopy. The metastasis of carcinoma was pathologically confirmed. Although the primary tumor was not detected on PET-CT re-examination, immunostaining of the biopsied lymph node specimen was positive for both the progesterone receptor and estrogen receptor. On the basis of these findings, the patient was diagnosed with paraneoplastic neurological syndrome due to potential breast cancer. The disorder is an immunological subacute sensory neuropathy with a longitudinally extensive spinal cord lesion of the dorsal column and a DRG lesion.
Full Text of this Article in Japanese PDF (8309K)

(CLINICA NEUROL, 54: 572|576, 2014)
key words: anti-amphiphysin antibody, breast cancer, subacute sensory neuropathy, longitudinally extensive spinal cord lesion of the dorsal column, dorsal root ganglion

(Received: 2-Oct-13)