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Immune mediated paraneoplastic neurological syndromes often become manifest before the underlying malignancy is detected. As a rule, these syndromes do not improve with antineoplastic treatment.1 We report on a case of a patient with small cell cancer with peripheral neurological syndromes that responded favourably to combination chemotherapy.
At the time of admission the patient, a 66 year old woman, had had a combination of peripheral neurological symptoms for 3 months: (a) muscle weakness and muscle pain of the legs so that she could not walk unattended; (b) a numbness of both legs from the foot to the middle of the thigh; (c) dryness of the eyes and mouth; and (d) severe constipation.
Clinical examination showed a load dependent, proximally accentuated symmetric muscle weakness and hypoaesthesia of the legs. The patient was unable to stand or walk without support. The deep tendon reflexes of the arms were decreased on both sides and leg reflexes could not be elicited. No pathological reflexes were detectable. Analysis of CSF yielded normal values for protein content, cell number, and glucose. Besides a slightly increased erythrocyte sedimentation rate (35 mm in the first hour), standard laboratory values showed no abnormalities. Abdominal auscultation and CT were unrevealing.
Electrophysiological investigation (somatosensory evoked potentials of the tibial and median nerves, EMG, and …