{"id":13959,"date":"2022-05-16T14:23:26","date_gmt":"2022-05-16T11:23:26","guid":{"rendered":"https:\/\/www.izmiregelab.com\/paraneoplastic-neurological-syndromes\/"},"modified":"2026-09-02T23:28:24","modified_gmt":"2026-09-02T20:28:24","slug":"paraneoplastic-neurological-syndromes","status":"publish","type":"post","link":"https:\/\/www.izmiregelab.com\/en\/paraneoplastic-neurological-syndromes\/","title":{"rendered":"PARANEOPLASTIC NEUROLOGICAL SYNDROMES"},"content":{"rendered":"<style>.elementor-13959 .elementor-element.elementor-element-19c2cd1e > .elementor-widget-container{margin:0px 0px 0px 0px;padding:0px 0px 0px 0px;}<\/style>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"13959\" class=\"elementor elementor-13959 elementor-7655\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2981b56c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2981b56c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-510efea7\" data-id=\"510efea7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4d4aa6a elementor-widget elementor-widget-heading\" data-id=\"4d4aa6a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Neurological Symptoms of Unexplained Cause\n In patients<br \/> This diagnosis should bring this to mind!<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2fb59b elementor-widget elementor-widget-heading\" data-id=\"b2fb59b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">PARANEOPLASTIC NEUROLOGICAL SYNDROMES<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-19c2cd1e elementor-widget elementor-widget-text-editor\" data-id=\"19c2cd1e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<blockquote>Paraneoplastic Neurological Syndrome (PNS) is a condition that occurs in patients with cancer\nand is not caused by the direct or local effects of the underlying tumor\n, nor by metastases,\nopportunistic infections, or side effects of cancer treatment\n, and for which a significant proportion is\nbelieved to result from autoimmune mechanisms\n.<\/blockquote>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c04dce4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c04dce4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2dc740c\" data-id=\"2dc740c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a46c99e elementor-widget elementor-widget-text-editor\" data-id=\"a46c99e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tParaneoplastic Neurological Syndrome (PNS) is a condition that occurs in cancer patients\nand is not caused by the direct or local effects of the underlying tumor\n, nor by metastases,\nopportunistic infections, or side effects of cancer treatment\n, and for which a significant proportion is\nbelieved to result from autoimmune mechanisms\n.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e7930de elementor-widget elementor-widget-image\" data-id=\"e7930de\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"450\" height=\"450\" src=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3.png\" class=\"attachment-large size-large wp-image-13963\" alt=\"\" srcset=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3.png 450w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3-300x300.png 300w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3-150x150.png 150w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3-230x230.png 230w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3-70x70.png 70w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-3-315x315.png 315w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-40efb7a elementor-widget elementor-widget-text-editor\" data-id=\"40efb7a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tAlthough it is known that PNSs are frequently observed (3\u201315%) in the course of small cell lung cancer\n(SCLC), thymoma, monoclonal gammopathy, and hematologic\nmalignancies\n, regarding the prevalence of PNS\nin all cancer cases, various studies have reported values ranging from\n1\/1,000 to 1\/10,000\n. Although PNSs occur rarely\n, they are significant because in most cases they develop before a cancer diagnosis is made\nand generally when the cancer is still very small and treatable\n. \n\nPNS findings that emerge following a cancer diagnosis may mimic neurological syndromes associated with opportunistic infections (\n) and the side effects of cancer treatment (\n).\nFurthermore, syndromes frequently observed in cancer patients\u2014such as\nlimbic encephalitis or subacute cerebellar degeneration\n\u2014do not always indicate an underlying cancer\n. Some neurological syndromes are more commonly seen in association with cancer\nor their clinical features\ndirectly suggest a paraneoplastic etiology.\nThese are referred to as \u201cclassic\u201d PNS.  Some syndromes, however,\ntypically occur in patients without cancer.\nThese are also referred to as \u201cnon-classical\u201d syndromes.\nIn \u201cnon-classic\u201d syndromes such as brainstem encephalitis, myasthenia gravis, and polymyositis\n, the likelihood of finding an associated cancer\nis low, and in these cases, it is necessary to prioritize screening for other\ncomplications of cancer\n. In addition, \u201cclassic syndromes\u201d associated with antibodies directed against ion channels\n\n can often present without an accompanying tumor.\nFor example, in cases of limbic encephalitis where voltage-\n-potassium channel (VGKC) antibodies are detected\n, a tumor\nhas been identified in only 20% of cases.  \t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-386febf elementor-widget elementor-widget-image\" data-id=\"386febf\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"450\" height=\"270\" src=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-5.png\" class=\"attachment-large size-large wp-image-13965\" alt=\"\" srcset=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-5.png 450w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-5-300x180.png 300w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8ac89ab elementor-widget elementor-widget-text-editor\" data-id=\"8ac89ab\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tThe most widely accepted view today is that the underlying tumor&#8230;\n similar antigenic properties between the nervous systems\n an autoimmune response resulting in the emergence of PNSs\n He is responsible for its emergence. In recent years, some\n Serum and cerebrospinal fluid (CSF) of PNS cases\n synthesized by various tumors in the samples\n nervous system antigens (paraneoplastic or\n antibodies developed against onconeural antigens\n This has been determined. In a significant number of these cases\n that there is intrathecal onconoral antibody synthesis\n This demonstrates the role of these antibodies in the pathogenesis of PNSs.\n This led people to believe that he was playing a role.   Also affected nerve\n The presence of inflammatory infiltration in systemic fields,\n via passive transfer of some onchoneural autoantibodies\n to enable the creation of experimental animal models and\n removes autoantibodies from circulation, such as plasmapheresis\n treatment methods lead to clinical improvement in some cases\n The fact that it leads to this has supported this view. In PNS cases\n identified autoantibodies, central and peripheral nerve\n in the membranes of system neurons or cells\n contained within (cytoplasm and\/or nucleus)\n It develops in response to antigens.\n The diagnosis of PNSs involves recognizing the neurological syndrome and its associated components.\n cancer detection and serum\/CSF antibodies\n It is diagnosed by detection. \t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c860c9 elementor-widget elementor-widget-image\" data-id=\"7c860c9\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"450\" height=\"270\" src=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-4.png\" class=\"attachment-large size-large wp-image-13964\" alt=\"\" srcset=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-4.png 450w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-4-300x180.png 300w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Image of an IFA preparation showing autoantibodies directed against neurons.<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-97560d1 elementor-widget elementor-widget-text-editor\" data-id=\"97560d1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tFor the detection of nervous system disorders and cancer.\n Imaging, CSF and EEG studies are used in the diagnostic process.\n These are methods that could be useful.\n CSF shows lymphocytic pleocytosis, increased protein, and high IgG levels.\n index and oligoclonal band presence are frequently encountered.\n These are the findings. CSF analysis also\n It should also be done to rule out leptomeningeal metastasis, and\n presence of atypical cells in the obtained CSF sample\n It should be investigated.\n Imaging of the affected area in all PNS cases.\n MRI scan (especially T2 and FLAIR) should be performed.\n (weighted sequences) metastasis and other cancer-related\n Useful for ruling out central nervous system diseases.\n It is a method. For the same reason, contrast enhancement should also be examined in these studies.    Most PNS\n In this case, the blood-brain barrier (BBB) \u200b\u200bwas preserved and\n Therefore, the probability of finding a contrast-enhancing lesion.\n The value is low. EEG examination reveals many paraneoplastic abnormalities.\n Non-convulsive symptoms that can be seen in encephalitis cases\n It is important to ensure that the status is not overlooked, and especially\n in cases presenting with confusion and altered consciousness\n should be implemented.\n PNSs usually develop in the early stages of cancer and\n Therefore, it is often possible to visualize the tumor.\n It may not be the case. The underlying tumor may be in the breast, abdomen, and pelvis.\n This can be shown with a CT scan. The syndrome or\n Identification and visualization of paraneoplastic antibodies.\n It enables better selection of the target area.    For example,\nin a case of anti-Yo-positive cerebellar ataxia,\nit is important to perform a mammogram and gynecological examination, or\nin a case of anti-Ma-positive encephalitis, to perform a testicular\nultrasound.\n18F-Fluorodeoxyglucose (FDG)-PET imaging allows for the detection of small\nprimary tumors and metastases and\nhelps identify potential sites for biopsy.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-323832e elementor-widget elementor-widget-image\" data-id=\"323832e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"235\" height=\"289\" src=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-7.png\" class=\"attachment-large size-large wp-image-13967\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">A. MRI image of a patient with cerebellar involvement<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e82a1ed elementor-widget elementor-widget-image\" data-id=\"e82a1ed\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"250\" src=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-8.png\" class=\"attachment-large size-large wp-image-13968\" alt=\"\" srcset=\"https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-8.png 400w, https:\/\/www.izmiregelab.com\/wp-content\/uploads\/2022\/05\/blog-8-300x188.png 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">B. MRI image of a patient with bilateral temporal lobe involvement<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-573035c elementor-widget elementor-widget-text-editor\" data-id=\"573035c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">Patients with classic PNS and those who test positive for well-characterized paraneoplastic antibodies but in whom no underlying tumor has been identified should be closely monitored for 5 years. In 80\u201390% of these patients, an underlying tumor becomes apparent within the first year. Cases in which classic PNS findings develop while the cancer is in remission should also be evaluated for cancer recurrence.  <\/p>\n<p class=\"p1\">Diagnostic criteria have been proposed for the diagnosis of PNS. According to these criteria, PNS cases are classified into two categories\u2014definite and probable\u2014based on the presence of cancer, well-characterized antibodies, and a classic syndrome:   <\/p>\n<p class=\"p1\">Definitive PNS criteria:<\/p>\n\n<ol class=\"ol1\">\n \t<li class=\"li1\">Diagnosis of the classic syndrome and cancer (within 5 years of the syndrome\u2019s diagnosis).<\/b><\/li>\n \t<li class=\"li1\">Identification of a nonclassical syndrome that has resolved or significantly improved following treatment of the tumor (there should be no concomitant immunotherapy, and the syndrome should not be a condition that can resolve spontaneously, such as myasthenia gravis).<\/b><\/li>\n \t<li class=\"li1\">Detection of antineuronal antibodies in association with a non-classical syndrome and cancer (with an interval of no more than 5 years).<\/b><\/li>\n \t<li class=\"li1\">The detection of well-characterized paraneoplastic antibodies (Hu, Yo, CV2, Ri, Ma2, amphiphysin) in the presence of a neurological syndrome (classic or otherwise), even in the absence of a concomitant cancer.<\/b><\/li>\n<\/ol>\n<p class=\"p1\">Possible PNS criteria:<\/b><\/p>\n\n<ol class=\"ol1\">\n \t<li class=\"li1\">The presence of a classic neurological syndrome and a high risk of cancer despite the absence of antibodies or evidence of cancer.<\/b><\/li>\n \t<li class=\"li1\">Detection of partially characterized antineuronal antibodies despite the absence of a neurological syndrome (classic or otherwise) or cancer.<\/b><\/li>\n \t<li class=\"li1\">Absence of antineuronal antibodies despite the diagnosis of a non-classical syndrome and cancer (within 2 years of the syndrome\u2019s diagnosis).  <\/b><\/li>\n<\/ol>\n<p class=\"p1\">For the effective treatment of PNS, it is important to recognize the clinical syndrome early, identify the underlying tumor and associated antibodies, and rapidly determine the paraneoplastic etiology. Once the diagnosis of PNS is confirmed, treatment proceeds to the stages of effective tumor therapy and immunosuppressive therapy. In cases where a tumor is detected, treatment should be initiated with tumor resection and chemotherapy, along with steroids, IV Ig, or plasmapheresis.    <\/b><\/p>\n<p class=\"p1\">While the response to treatment is poor in syndromes associated with intracellular antigens\u2014even after tumor treatment and immunosuppression\u2014the response to treatment is good in syndromes associated with cell membrane antigens. Even in this second group, patients may die if treatment is not started early and the underlying tumor is not removed. For this reason, early diagnosis and treatment are the most important factors affecting the prognosis of PNSs.  <\/b><\/p>\n<p class=\"p2\">REFERENCE:<\/b><\/p>\n<p class=\"p3\">Erdem T\u00dcZ\u00dcN. Paraneoplastic Syndromes with Neurological Manifestations. Clinical Development. 2010-1, pp. 71\u201377.   <\/b><\/p>\n<p class=\"p1\">Darnell, R.B. et al. Mechanisms of Disease: Paraneoplastic Syndromes Involving the Nervous System. N Engl J Med 2003;349:1543-54. <\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Neurological Symptoms of Unexplained Cause In patients This diagnosis should bring this to mind! PARANEOPLASTIC NEUROLOGICAL SYNDROMES Paraneoplastic Neurological Syndrome (PNS) is a condition that occurs in patients with cancer and is not caused by the direct or local effects of the underlying tumor , nor by metastases, opportunistic infections, or side effects of cancer&#8230;<\/p>\n","protected":false},"author":1,"featured_media":13961,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[125],"tags":[126],"class_list":["post-13959","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-checkup"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/posts\/13959","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/comments?post=13959"}],"version-history":[{"count":1,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/posts\/13959\/revisions"}],"predecessor-version":[{"id":13970,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/posts\/13959\/revisions\/13970"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/media\/13961"}],"wp:attachment":[{"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/media?parent=13959"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/categories?post=13959"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.izmiregelab.com\/en\/wp-json\/wp\/v2\/tags?post=13959"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}