General description

Paraneoplastic myelopathy is a rare but severe spinal cord disorder caused by an autoimmune response triggered by solid or blood cancers. It is characterized by rapidly progressive spastic paresis, bowel and bladder dysfunction, and sometimes associated nervous system involvement, such as encephalitis or optic neuropathy. The most commonly associated cancer is small cell lung cancer (SCLC), though it has also been reported in breast, kidney, thyroid, gynecologic cancers, and melanoma.

The condition is mediated by autoantibodies, with the most commonly identified being anti-Hu, anti-collapsin-responsive mediator protein 5 (CRMP5), and anti-amphiphysin antibodies. Symptoms progress rapidly, making early recognition and diagnosis crucial for managing this potentially life-threatening paraneoplastic syndrome.

Radiographic features

Spinal cord MRI findings in paraneoplastic myelopathy are characterized by longitudinally extensive, symmetric T2-signal changes involving specific tracts, such as the lateral and posterior columns, or gray matter. These changes may occasionally exhibit symmetric gadolinium enhancement.