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首页> 外文期刊>The Internet Journal of Neurology >Gastric Carcinoma Presenting With Chronic Inflammatory Demyelinating Polyneuropathy
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Gastric Carcinoma Presenting With Chronic Inflammatory Demyelinating Polyneuropathy

机译：胃癌伴慢性炎症性脱髓鞘性多发性神经病

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Although paraneoplastic neuropathy is usually associated with lung cancer, this report describes an association with gastric adeno-carcinoma. We report on a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) manifesting as a paraneoplastic complication of gastric carcinoma. Due to motor and sensory deficits in the lower limbs his ambulation was severely limited. The onset was subacute, followed by a slow progression. Electrodiagnostic examination and sural nerve biopsy were consistent with CIDP. The patient received chemotherapy and experienced clinically meaningful improvement of symptoms. We thus conclude that CIDP should be considered in patients known to have gastric adenocarcinoma who present with a polyneuropathy. To our knowledge this is the first reported case of paraneoplastic CIDP secondary to gastric adenocarcinoma. Introduction Paraneoplastic processes are well established causes of neuropathies. These neuropathies have been associated with small cell carcinoma of the lung, ovarian or uterine cancer and rarely with cancers of the digestive system organs. We describe a unique patient with CIDP who was later diagnosed and treated for gastric adenocarcinoma with a subsequent improvement of symptoms. Case report The patient was a fifty five-year-old, right-handed white male with a 6-7 week history of progressively worsening numbness. The numbness started in the right leg below the knee, and subsequently involved the left leg below the knee as well as in both hands. There was an associated worsening of a right foot drop dating from prior back surgeries. He denies any upper respiratory or gastrointestinal illness prior to the onset of his symptoms. He had diarrheal episodes after he was hospitalized. Patient continued to progress gradually for few months after his initial symptoms. His past medical history was significant for a melanoma removed in 1976. He had multiple other previous surgeries, including cervical fusion, lumbar laminectomies, bilateral knee and hip replacement, bilateral shoulder replacement and multiple ankle surgeries. A review of systems was significant for a 50 lb. weight loss over the previous 6 months.Neurological examination revealed a normal mental status with intact cranial nerves bilaterally. Motor examination revealed intact strength except for right foot dorsiflexors and everter 0-1/5 and mild bilateral hip flexor weakness. Mildly decreased tone in the right foot. Deep tendon reflexes been 2 and equal bilaterally in the upper extremities, reduced bilateral patellar and absent at the ankles. Sensory examination showed decreased pin sensation bilateral up to the mid-thighs and mid-arms bilaterally. There was decreased vibration bilaterally up to the elbows and decreased position at the toes. Finger-to-nose and heel-to-shin testing was unremarkable. Plantars were flexors. The patient walked with a steppage gait on right side. There was positive Romberg.Laboratory tests with normal ranges are shown in the Table. The sural nerve biopsy is shown in Figure-1 A & B. Electrodiagnostic findings revealed a multifocal process with demyelinating changes. A cerebrospinal fluid analysis was not performed. There was no history of exposure to neurotoxins. The clinical history, findings on physical examination and laboratory studies did not support an infectious or metabolic neuropathy. The patient's megaloblastic blood picture with borderline elevated liver functions was attributed to alcohol use.As the patient continued to loose weight and appetite, his workup was repeated. Initial gastro-intestinal workups was negative but repeat gastro-intestinal workups including endoscopy and colonoscopy 8-9 months after the start of his neurologic symptoms revealed gastric adenocarcinoma. The patient's neuropathic symptoms continued to progress for the 8-9 months until his gastric adeno-carcinoma was diagnosed. He was then treated with chemotherapy with partial resolution of his neurologic symptoms. T
机译：尽管副肿瘤性神经病变通常与肺癌有关，但该报告描述了与胃腺癌的相关性。我们报告的慢性炎症性脱髓鞘性多发性神经病（CIDP）表现为胃癌的副肿瘤并发症。由于下肢的运动和感觉缺陷，他的下肢活动受到严重限制。起病是亚急性的，随后进展缓慢。电诊断检查和腓肠神经活检与CIDP一致。该患者接受了化学疗法并经历了临床上有意义的症状改善。因此，我们得出结论：已知患有多发性神经病的胃腺癌患者应考虑CIDP。据我们所知，这是继胃腺癌后继发的副肿瘤性CIDP的首例报道。简介副肿瘤过程是神经病的公认原因。这些神经病与肺癌，卵巢癌或子宫癌的小细胞癌有关，很少与消化系统器官的癌症有关。我们描述了一个独特的CIDP患者，后来被诊断并治疗了胃腺癌，随后症状得到改善。病例报告该患者是一个55岁的右撇子白人男性，有6-7周的逐步麻木病史。麻木开始于膝盖以下的右腿，随后累及膝盖以下的左腿以及双手。先前的背部手术可导致右脚下降的相关恶化。在症状发作之前，他否认有任何上呼吸道或胃肠道疾病。他住院后出现腹泻发作。最初症状出现后的几个月，患者继续逐渐发展。对于1976年切除的黑色素瘤，他过去的病史具有重要意义。他之前曾做过其他多项手术，包括颈椎融合术，腰椎切开术，双侧膝关节和髋关节置换术，双侧肩关节置换术和多处踝关节手术。在过去的6个月中，系统检查发现体重减轻了50磅。神经系统检查显示双侧颅神经完整，精神状态正常。运动检查显示除了右脚背屈和0-1 / 5臂弯曲以及轻度的双侧髋屈肌无力外，强度无变化。右脚轻度减弱。上肢深部肌腱反射为2，双侧相等，双侧tell骨减少，踝部缺如。感觉检查显示双侧直至大腿中部和双侧中臂的双脚感觉均下降。直至肘部的双侧振动均减小，脚趾的位置减小。手指至鼻子和脚跟至胫骨测试不明显。足底是屈肌。病人走路时步态在右侧。 Romberg呈阳性。正常范围内的实验室测试列于表中。腓肠神经活检示于图1 A和B。电诊断结果显示多灶性过程伴有脱髓鞘改变。没有进行脑脊液分析。没有接触神经毒素的历史。临床病史，体格检查和实验室检查结果均不支持感染性或代谢性神经病。该患者的巨幼细胞血液图像显示肝功能临界升高归因于饮酒。随着患者体重和食欲的持续下降，他的检查工作得以重复。最初的胃肠道检查为阴性，但在其神经系统症状开始显示胃腺癌后8-9个月重复胃肠道检查，包括内窥镜检查和结肠镜检查。患者的神经病理症状持续发展了8-9个月，直到诊断出胃腺癌。然后，他接受了化学疗法治疗，部分缓解了神经系统症状。 Ť

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