OVERVIEW
Overview of Paraneoplastic Syndrome
Paraneoplastic syndrome refers to the clinical manifestations that occur as a result of an abnormal immune response to tumor products (including ectopic hormone production) or other unknown causes, causing lesions in systems including the endocrine, neurological, digestive, hematopoietic, osteoarthritic, renal, and cutaneous systems. These manifestations are not directly caused by the site of the primary tumor or metastases, but indirectly through the above mentioned pathways. Spinal cord lesions belong to one of the above mentioned neurological lesions, which can be manifested as necrotizing myelopathy, subacute motor neuron disease, etc. The clinical manifestation is the damage of the spinal cord. Clinical manifestations include muscle weakness and sensory deficits in the area innervated by the damaged spinal cord.
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Department
Neurology, Medical Oncology
Clinical Symptoms
Muscle weakness and sensory deficits in the area innervated by the injured spinal cord.
Hazards
It can lead to paraplegia, incontinence, weakness of respiratory muscles, etc., which may cause the patient to lose the ability to move or take care of himself/herself, or even endanger his/her life.
Examination
Physical examination, autoantibody test, CT, magnetic resonance imaging, neuromuscular electrophysiological examination, etc.
Diagnosis
Diagnosis can be made by combining the clinical manifestations of muscle weakness with autoantibody test and imaging examination.
Treatment principle
To treat the primary tumor, drugs such as vitamins, corticosteroids and immunosuppressants can be tried.
Curability
Mainly depends on the primary tumor.
Dietary recommendations
Balanced diet and supplementation.
Etiology
Etiology
May be related to direct damage or autoimmune response caused by tumor secretions.
Symptoms and Diagnosis
Typical symptoms
This disease mainly manifests as muscle weakness and sensory impairment in the innervated area of the damaged spinal cord.1. Necrotizing myelopathy: patients may have asymmetric weakness of both lower limbs as the first symptom, and paraplegia, urinary incontinence, respiratory muscle weakness, etc., accompanied by sensory impairment, without pain, may appear with the rise of the damaged plane of the spinal cord.2. Subacute motor neuron disease: the clinical manifestation is progressive weakness of both lower limbs, without pain, and upper limbs are lightly affected, and some patients may have mild sensory abnormalities. Some patients may have mild sensory abnormalities.
Diagnostic basis
1. The patient has a history of malignant tumor, muscle weakness and sensory impairment. Physical examination may reveal damaged sensory planes.2. Blood or cerebrospinal fluid autoantibody test may show positive results of autoantibodies, such as anti-neuronal antibodies.3. Magnetic resonance imaging may show swelling of the spinal cord in the lesion segment of necrotizing myelopathy.4. Histopathological examination may show transverse large necrosis in the damaged segment of necrotizing myelopathy, and inflammatory reactions are rarely seen; subacute motor neuron disease is characterized by loss of spinal cord anterior horn cells, The changes of subacute motor neuron disease are loss of anterior horn cells, degenerative changes, spinal cord white matter can also be seen in the form of patchy demyelination changes, the lesions of the posterior cord of the spinal cord are more obvious, the spinal cord has no inflammatory reaction, and there are no lesions of the lateral cords of the spinal cord.5. The electromyography of the subacute motor neuron disease shows the loss of nerve potentials, and the motor and sensory conduction velocities are basically normal.
Treatment
Treatment guidelines
To treat the primary tumor, drugs such as vitamins, corticosteroids and immunosuppressants can be tried.
Drug therapy
Vitamins, corticosteroids and immunosuppressants can be tried.
Radiotherapy
According to the type of primary tumor, select the appropriate tumor regimen.
Other treatments
Plasma exchange can be tried.
Prognosis
The prognosis is related to the primary tumor and the degree of spinal cord injury.
Nursing care
Daily care
1. Keep the living environment quiet and comfortable, pay attention to rest, avoid exertion and adverse stimuli. 2. Actively carry out functional exercises and appropriate sports after the symptoms are relieved to restore muscle function and improve physical fitness. 3. Maintain a good state of mind, actively treat the disease, and avoid adverse emotions such as fear and anxiety. 4.
Diet regulation
Balanced diet, supplemental nutrition, intake of high calorie, high protein, rich in dietary fiber of all kinds of nutrients, diet should be light, easy to digest.