Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Neurol Clin. 2013 Feb;31(1):307-18. doi: 10.1016/j.ncl.2012.09.001.
Paraneoplastic causes are a rare but important diagnostic consideration when evaluating myelopathy because neurologic symptoms may herald a diagnosis of cancer. Spinal cord MRI findings of longitudinally extensive, symmetric, tract-specific T2-signal changes occasionally with gadolinium enhancement are characteristic. Detection of neural-specific autoantibodies assists in confirming the diagnosis and guides the cancer search. Initial management involves detection and treatment of the underlying cancer. Combinations of immunotherapies are typically recommended but evidence-based therapeutic guidelines are lacking and morbidity remains high. Autoimmune myelopathies may also occur in association with neural-specific autoantibodies without an underlying cancer and in association with systemic autoimmune disorders.
副肿瘤性原因是评估脊髓病变时一个罕见但重要的诊断考虑因素，因为神经症状可能预示着癌症的诊断。脊髓 MRI 表现为长节段、对称、特定于束的 T2 信号改变，偶尔伴有钆增强，具有特征性。神经特异性自身抗体的检测有助于确认诊断并指导癌症的寻找。初始治疗包括检测和治疗潜在的癌症。通常推荐联合免疫治疗，但缺乏基于证据的治疗指南，发病率仍然很高。自身免疫性脊髓病也可能与潜在癌症无关，或与系统性自身免疫性疾病相关，同时伴有神经特异性自身抗体。
