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Paraneoplastic neurological syndromes including paraneoplastic limbic encephalitis are neurological disorders that occur in patients with cancer. 1- 6 Paraneoplastic limbic encephalitis is often associated with small cell lung carcinoma and testicular germ cell tumours. 1- 6
Recently, it was suggested that anti-Ma2 associated encephalitis differs from classic paraneoplastic limbic encephalitis because of its variable clinical features. 6
Here, we report the clinical and neuroradiological findings in a patient with an anti-Ma2 associated paraneoplastic neurological syndrome who presented with encephalitis and progressive muscular atrophy.
To our knowledge, this is the first report describing the unique clinical features of a cervical spinal cord lesion confirmed by magnetic resonance imaging (MRI) in a patient with anti-Ma2 associated paraneoplastic neurological syndrome.
CASE REPORT
A 36 year old man was admitted to our hospital for progressive amnesia, hypersomnia, diplopia, and generalised convulsions in September 2003.
He had undergone a bilateral orchidectomy for testicular germ cell tumour six months before presentation. There was no recurrence of the tumour noted at the time of presentation.
On admission, the patient presented with confusion and seizures. There was no cerebellar ataxia or sensory disturbance noted on examination. Progressive muscular atrophy, weakness, and fasciculations of the upper extremities, shoulder girdle, and neck began eight months after initial presentation. Thereafter, he developed flaccid paralysis of the upper extremities and a head drop. A Babinski's sign was present bilaterally.
Cerebrospinal fluid (CSF) contained 5 x 103 lymphocytes/litre and 830 mg protein/litre. There were no atypical lymphocytes or tumour-like cells noted in the CSF. IgM titres for herpes simplex were negative. Muscle computed tomography at the level of C5 demonstrated severe muscular atrophy...