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Multiple cranial neuropathies as a manifestation of paraneoplastic syndrome in thymoma

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Neurological symptoms could be a manifestation of cancer both with direct involvement of the nervous system (tumor invasion, metastasis, compression of nerve tissue by neoplasm) and its mediated damage in patients with paraneoplastic syndromes. Neurological manifestations in this syndrome are more likely to cause neoplasms that produce neuroendocrine proteins (small-cell lung cancer, neuroblastoma) or involve immune system organs (thymomas, lymphomas, plasmacytomas). The paraneoplastic syndrome can be observed ahead of tumor detection and verification in some cases, so cancer screening can be a successful evaluation tactic in patients with neurological symptoms of undetermined etiology.

To illustrate this diagnostic approach, we present the clinical case of a patient with multiple cranial neuropathies as a malignant thymoma manifestation. Symptoms of multiple neuropathies developed in the 20-year-old woman within two months prior to hospitalization. The differential diagnosis included infectious, autoimmune, vascular diseases, diseases manifested by hyperostosis of the skull bones, and oncological diseases. Magnetic resonance imaging of the brain with contrast revealed a pathological accumulation of contrast in the oculomotor, trigeminal, vestibulocochlear, and vagus nerves. Computed tomography of the thorax and abdomen showed signs of neoplasms of the mediastinum, right lung, liver, right adrenal gland, and left kidney. Antemortem pathology study of the material obtained by Video-assisted thoracoscopic biopsy from a mediastinal neoplasm revealed a malignant thymoma.

Patients with multiple cranial neuropathies are often encountered in neurological practice. However, establishing the cause of this condition is a complex medical task due to many diseases with which it will be necessary to conduct a differential diagnosis.

About the Authors

G. R. Ramazanov

Russian Federation

E. V. Shevchenko

Russian Federation

L. I. Idilova

Russian Federation

V. N. Stepanov

Russian Federation

A. M. Izmailova

Russian Federation

S. S. Petrikov

Russian Federation


1. Chertousova AE, Chernikova IV. Paraneoplastic syndromes in neurology. Nervnyye bolezni. 2018;(1):32-8. doi: 10.24411/2226-0757-2018-11995 (In Russ.).

2. Clouston PD, DeAngelis LM, Posner JB. The spectrum of neurological disease in patients with systemic cancer. Ann Neurol. 1992;31(3):268-73. doi: 10.1002/ana.410310307

3. Kanikannan MA, Sirisha Y, Uppin MS, et al. Incidence and spectrum of paraneoplastic neurological syndromes: single center study. J Neurooncol. 2015;125(1):197-206. doi: 10.1007/s11060-015-1898-7

4. Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010 Sep;85(9):838-54. doi: 10.4065/mcp.2010.0099

5. Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet. Neurology. 2008;7(4):327-40. doi: 10.1016/S1474- 4422(08)70060-7

6. Hammam T, McFadzean RM, Ironside JW. Anti-hu paraneoplastic syndrome presenting as bilateral sixth cranial nerve palsies. J Neuroophthalmol. 2005;25(2):101-4. doi: 10.1097/01.wno.0000165103.01237.f1

7. Baser ME, Friedman JM, Wallace AJ, et al. Evaluation of clinical diagnostic criteria for neurofibromatosis 2. Neurology. 2002;59(11):1759- 65. doi: 10.1212/01.wnl.0000035638.74084.f4

8. Saremi F, Helmy M, Farzin S, et al. MRI of cranial nerve enhancement. AJR Am J Roentgenol. 2005;185(6):1487-97. doi: 10.2214/AJR.04.1518

9. Kaido M, Yuasa Y, Yamamoto T, et al. A case of possible paraneoplastic neurological syndrome presenting as multiple cranial nerve palsies associated with gallbladder cancer. RinshoShinkeigaku. 2016;56(9):617-21. doi: 10.5692/

10. Renna R, Plantone D, Batocchi AP. Teaching NeuroImages: a case of hearing loss in a paraneoplastic syndrome associated with anti-Hu antibody. Neurology. 2012;79(15):e134. doi: 10.1212/WNL.0b013e31826e262b

11. Paul R, Ghosh AK, Sinha A, Bhattacharya R. Paraneoplastic optic neuritis as the first manifestation of periampullary carcinoma. Int J Appl Basic Med Res. 2015;5(1):73-5. doi: 10.4103/2229-516X.149255

12. Madhavan AA, Carr CM, Morris PP, et al. Imaging Review of Paraneoplastic Neurologic Syndromes. AJNR Am J Neuroradiol. 2020;41(12):2176-87. doi: 10.3174/ajnr.A6815

13. Keane JR. Multiple cranial nerve palsies: analysis of 979 cases. Arch Neurol. 2005;62(11):1714-7. doi: 10.1001/archneur.62.11.1714


For citations:

Ramazanov G.R., Shevchenko E.V., Idilova L.I., Stepanov V.N., Izmailova A.M., Petrikov S.S. Multiple cranial neuropathies as a manifestation of paraneoplastic syndrome in thymoma. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(1):104-107. (In Russ.)

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