York Teaching Hospital NHS Foundation Trust, York, UK, E-mail:
Neurosciences (Riyadh). 2020 Oct;25(5):403-405. doi: 10.17712/nsj.2020.5.20200095.
We report the case of a lady who presented with 3 weeks of visual floaters and optic disc swelling. Subsequent investigations revealed deep white matter changes on brain imaging, and enlarged mediastinal nodes. The presence of anti-CRMP-5 antibodies finally led to the diagnosis of a paraneoplastic syndrome, and mediastinal lymph node biopsy confirmed the diagnosis of small-cell lung cancer. The learning points from this case include that optic neuritis can be the only presenting feature of a paraneoplastic neurological syndrome, and the usefulness of anti-neuronal antibody measurement as a diagnostic marker of an underlying paraneoplastic disease process. The great challenge is to recognise these tumour-associated autoimmune system presentations early, as they often appear long before the primary cancer is evident. Prompt treatment leads to an earlier reduction in circulating auto-antibody possibly due to reduction in tumour size, and thus less likelihood of permanent neuronal damage.
我们报告了一例女性患者，其出现了 3 周的视觉漂浮物和视盘肿胀。进一步的检查显示脑部成像存在深部白质改变，且纵隔淋巴结肿大。抗 CRMP-5 抗体的存在最终导致了副肿瘤综合征的诊断，纵隔淋巴结活检证实了小细胞肺癌的诊断。该病例的学习要点包括视神经炎可能是副肿瘤性神经综合征的唯一表现，以及神经元抗体测量作为潜在副肿瘤性疾病过程的诊断标志物的有用性。巨大的挑战是早期识别这些与肿瘤相关的自身免疫系统表现，因为它们通常在原发性癌症出现之前很久就已经出现了。早期治疗可能会导致循环自身抗体的早期减少，这可能是由于肿瘤缩小，从而减少了永久性神经元损伤的可能性。
