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A case of paraneoplastic myelopathy associated with the neuromyelitis optica antibody

Nature Clinical Practice Neurology volume 4, pages 284–288 (2008)Cite this article

Abstract

Background A 63-year-old woman with a history of metastatic breast cancer presented to the emergency department with chest pain in a band-like distribution. Within 1 day of presentation the patient developed bilateral lower-extremity weakness and urinary retention. The emergence of these symptoms coincided with the recurrence of her metastatic breast cancer. Fifteen months before presentation the patient had experienced a similar episode of myelopathy in the setting of recurrence of her breast cancer, from which she recovered completely following treatment with steroids.

Investigations General and neurological examination, routine laboratory testing, MRI of the brain and spine, tests for serum autoimmune antibodies, infectious serology testing, lumbar puncture, paraneoplastic panel, neuromyelitis optica antibody testing, evaluation for celiac disease, CT scans of the chest, abdomen and pelvis, whole-body [18F]fluoro-2-deoxyglucose PET scan, lymph node biopsy, electroencephalography observing visual and brainstem auditory evoked potentials, and neuro-ophthalmological examination.

Diagnosis Myelopathy, possibly paraneoplastic, associated with the neuromyelitis optica antibody in the setting of metastatic breast cancer.

Management Corticosteroids to treat the myelopathy and chemotherapy for the breast cancer.

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Figure 1: Spinal MRI results before and after treatment with corticosteroids.

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Acknowledgements

The authors thank Dr Vanda A Lennon for performing the testing for the neuromyelitis optica antibody.

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Authors and Affiliations

  1. DB Dubal is a Clinical Fellow and SA Josephson is a Clinical Assistant Professor in the Department of Neurology, S Mueller is a Pediatric Neurology Fellow, University of California San Francisco, San Francisco. DB Dubal is also a Postdoctoral Fellow at the Gladstone Institute, San Francisco, CA, USA.,

    Sabine Mueller, Dena B Dubal & S Andrew Josephson

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  1. Sabine Mueller
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  2. Dena B Dubal
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  3. S Andrew Josephson
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Corresponding author

Correspondence to S Andrew Josephson.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Summary of reported malignancies associated with paraneoplastic myelopathy (DOC 45 kb)

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Mueller, S., Dubal, D. & Josephson, S. A case of paraneoplastic myelopathy associated with the neuromyelitis optica antibody. Nat Rev Neurol 4, 284–288 (2008). https://doi.org/10.1038/ncpneuro0765

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