Multiple cranial neuropathies as a manifestation of paraneoplastic syndrome in thymoma

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.

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