Paraneoplastic neuropathies

These occur as remote effects of a carcinoma and can precede detection of malignancy by months to years. Of the various types, a predominantly distal, symmetrical sensory, or sensorimotor polyneuropathy is the most common. A purely sensory neuronopathy (Denny-Brown syndrome, dorsal root ganglionitis), in which pain can be a distressing symptom, is rarely observed. There are three major manifestations of neuronopathy: an ataxic syndrome, a hyperalgesic-ataxic syndrome, and an ataxic or hyperalgesic-ataxic syndrome with prominent gastrointestinal dysmotility.54 In patients with the hyperalgesic type, painful paresthesiae, burning sensations, and shooting limb pains are the usual presenting symptoms. These may be associated with ataxia or abdominal complaints. There is usually very little motor loss, and the sensory loss may be either proximal or distal. This syndrome is typically associated with small-cell carcinoma of lung, but can occur with other malignancies. The prognosis is related to that of the underlying carcinoma. The paraneoplastic neuropathies have been reviewed.54,55

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