Signs and symptoms of paraneoplastic syndromes of the nervous system usually develop relatively quickly, often over days to weeks. Signs and symptoms vary depending on the body part being injured, and may include:
- Difficulty walking
- Difficulty maintaining balance
- Loss of muscle coordination
- Loss of muscle tone or weakness
- Loss of fine motor skills, such as picking up objects
- Difficulty swallowing
- Slurred speech
- Memory loss and other thinking (cognitive) impairment
- Vision problems
- Sleep disturbances
- Sensory disturbances
- Unusual involuntary movements
Types of paraneoplastic syndromes
Some symptoms of these disorders often occur in patterns or clusters which are seen as a recognizable syndrome. When these syndromes clearly co-occur with a cancer, they are designated as paraneoplastic syndromes.
Sometimes, very similar neurological disorders may result from an immune system disease process unrelated to cancer. Therefore, neurological disorders are identified as paraneoplastic syndromes only when there is a definite or probable association with cancer.
Common paraneoplastic syndromes of the nervous system include:
- Cerebellar degeneration. This is the loss of nerve cells in the area of the brain that controls muscle functions and balance (cerebellum). Signs and symptoms may include unsteady or impaired walking, lack of muscle coordination in your limbs, inability to maintain your trunk posture, dizziness, nausea, involuntary eye movement, double vision, difficulty speaking, or difficulty swallowing.
- Limbic encephalitis. This is inflammation affecting a region of the brain known as the limbic system, which controls emotions, behaviors and certain memory functions. People with this disorder may experience personality changes or mood disturbances, memory loss, seizures, hallucinations, or sleep disturbances.
- Encephalomyelitis. This syndrome refers to inflammation of the brain and spinal cord. There may be a wide variety of symptoms and signs depending on the area affected.
- Opsoclonus-myoclonus. This syndrome is due to dysfunction of the cerebellum or its connections. It can cause rapid, irregular eye movements (opsoclonus) and involuntary, chaotic muscle jerks (myoclonus) in your limbs and trunk.
- Stiff person syndrome. Previously called stiff man syndrome, this syndrome is characterized by progressive, severe muscle stiffness or rigidity, mainly affecting your spine and legs. It may also cause painful muscle spasms.
- Myelopathy. This term refers to a syndrome of injury limited to the spinal cord. It sometimes is called transverse myelitis. Depending on the level of spinal cord injury, you may have changes in bowel and bladder function, and severe weakness and numbness up to a certain level in your body. If the level of injury includes your neck, you can have severe disability affecting all four limbs.
Lambert-Eaton myasthenic syndrome. This is a syndrome caused by disrupted communication between nerves and muscles. Signs and symptoms include muscle weakness, fatigue, difficulty swallowing, difficulty speaking, irregular eye movement and double vision. Autonomic nervous system problems can include dry mouth, impotence and failure to sweat.
When it occurs as a paraneoplastic syndrome, Lambert-Eaton syndrome is typically associated with lung cancer.
Myasthenia gravis. Myasthenia gravis is also related to disrupted communication between nerves and muscles and also characterized by weakness and rapid fatigue of any of the muscles that are under voluntary control, including muscles in your face, eyes, arms and legs. The muscles involved in chewing, swallowing, talking and breathing may be affected as well.
When myasthenia gravis occurs as a paraneoplastic syndrome, it is typically associated with cancer of the thymus gland (thymoma).
- Neuromyotonia. Neuromyotonia — also known as Isaacs syndrome and peripheral nerve hyperexcitability — is characterized by abnormal impulses in nerve cells outside the brain and spinal cord (peripheral nerves) that control muscle movement. These impulses can cause twitching, muscle rippling that looks like a "bag of worms," progressive stiffness, muscle cramps, slowed movement and other muscle impairments.
- Peripheral neuropathy. This condition refers to patterns of damage to nerves that transmit messages from the brain or spinal column to the rest of your body. When damage involves only the sensory nerves of the peripheral nervous system, you can have pain and disturbances in sensation anywhere in your body.
- Dysautonomia. Dysautonomia refers to a wide range of signs and symptoms resulting from injury to the nerves that regulate nonvoluntary body functions (autonomic nervous system), such as heart rate, blood pressure, sweating, and bowel and bladder functions. When this part of the nervous system is affected, the most common symptoms are low blood pressure and nausea, bloating, and weight loss.
When to see a doctor
The signs and symptoms of paraneoplastic syndromes of the nervous system are similar to those of many conditions. If you have any signs or symptoms suggesting a paraneoplastic syndrome, see your doctor as soon as possible. Early diagnosis and appropriate care can be extremely important.
April 30, 2014
- NINDS paraneoplastic syndrome information page. National Institutes of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/paraneoplastic/paraneoplastic.htm. Accessed Dec. 18, 2013.
- Niederhuber JE, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Pelosof LC, et al. Paraneoplastic syndromes: An approach to diagnosis and treatment. Mayo Clinic Proceedings. 2010;85:838.
- Giometto B, et al. Treatment for paraneoplastic neuropathies (Review). Cochrane Database of Systematic Reviews. http://ovidsp.tx.ovid.com/sp-3.10.0b/ovidweb.cgi?&S=BOJHFPHGIFDDNBEPNCNKNAIBLMNOAA00&Link+Set=S.sh.18%7c1%7csl_50. Accessed Dec. 18, 2013.
- Titulaer MJ, et al. Screening for tumours in paraneoplastic syndromes: Report of an EFNS Task Force. European Journal of Neurology. 2011;18:19.
- Graus F, et al. Paraneoplastic neurological syndromes. Current Opinion in Neurology. 2012;25:795.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014.
https://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Dec. 15, 2013.
- van Sonderen A, et al. Paraneoplastic syndromes of the neuromuscular junction: Therapeutic options in myasthenia gravis, Lambert-Eaton myasthenic syndrome, and neuromyotonia. Current Treatment Options in Neurology. 2013;15:224.
- Tarin D. Update on clinical and mechanistic aspects of paraneoplastic syndromes. Cancer Metastasis Review. 2013;32:707.
- Schramm N, et al. Detection of underlying malignancy in patients with paraneoplastic neurological syndromes: Comparison of 18F-FDG PET/CT and contrast-enhanced CT. European Journal of Nuclear Medicine and Molecular Imaging. 2013;40:1014.
- NINDS dysautonomia information page. National Institutes of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dysautonomia/dysautonomia.htm. Accessed Jan. 22, 2014.
- NINDS Isaac's syndrome information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/Isaacs_syndrome/Isaacs_syndrome.htm. Accessed Dec. 18, 2013.
- Dalmau J, et al. Overview of paraneoplastic syndromes of the nervous system. http://www.uptodate.com/home. Accessed Dec.18, 2013.
- Pittock SJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 14, 2010.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery. Accessed Dec. 30, 2013.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/pediatric-rankings/neurology-and-neurosurgery. Accessed Dec. 30, 2013.
- Lachance DH (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 15, 2014.
- Eisen A. Disorders affecting the spinal cord. http://www.uptodate.com/home. Accessed Jan. 23, 2014.