Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Muscle Nerve. 2012 Nov;46(5):823-7. doi: 10.1002/mus.23464.
Paraneoplastic lower motor neuronopathies have been reported rarely with Hodgkin lymphoma.
We report a case of rapidly progressive motor neuronopathy preceding the diagnosis of Hodgkin lymphoma.
A 31-year-old woman developed subacute rapidly progressive quadriparesis. Electrodiagnostic studies revealed a severe diffuse disorder of motor neurons and their axons. Symmetric enhancement of the cauda equina motor nerve roots was notable on magnetic resonance imaging scan. Further imaging demonstrated an enlarged supraclavicular lymph node, and biopsy revealed Hodgkin lymphoma. A final diagnosis of paraneoplastic motor neuronopathy was made after investigations for alternative causes of motor neuronopathy were unrevealing. Neurological improvement was seen with combined treatment of the underlying malignancy and intravenous immunoglobulin.
Paraneoplastic causes should be considered in the differential diagnosis of subacute motor neuronopathy, as the neurological presentation may precede cancer detection. Combinations of lymphoma treatment and immunotherapy may result in a favorable outcome.
副肿瘤性下运动神经元病罕有报道与霍奇金淋巴瘤相关。
我们报告了一例在霍奇金淋巴瘤诊断前发生的快速进展性运动神经元病。
一名 31 岁女性出现亚急性快速进展性四肢瘫痪。电诊断研究显示严重弥漫性运动神经元及其轴突疾病。磁共振成像扫描显示马尾神经根对称性增强明显。进一步的影像学检查显示锁骨上淋巴结肿大，活检显示霍奇金淋巴瘤。在对运动神经元病的其他病因进行调查后未发现异常，最终诊断为副肿瘤性运动神经元病。在治疗潜在恶性肿瘤和静脉注射免疫球蛋白的联合治疗下，神经功能得到改善。
在亚急性运动神经元病的鉴别诊断中应考虑副肿瘤性原因，因为神经表现可能先于癌症发现。淋巴瘤治疗和免疫治疗的联合可能会产生良好的结果。
