Paraneoplastic Hu Syndrome

Case Study A
A 60-year-old woman, previously healthy except for a long history of smoking, developed numbness and tingling in all four extremities. Over a six week period the symptoms progressed to the point where she was unable to walk without the support of two people. She dropped objects from her hands when she was not looking at them and she could not write legibly. She had also noted a ten pound weight loss in the previous three months. Examination was normal, except for profound loss in all modalities of sensation to the mid-thigh in the lower extremities and to the mid-forearm in the upper extremities. Deep tendon reflexes were absent and sensory ataxia was profound.

Laboratory examination revealed normal motor nerve conduction velocities and a normal EMG, but absent sensory potentials. The cerebrospinal fluid contained fifteen lymphocytes, a protein of 65mg/dl and oligoclonal bands. Both serum and spinal fluid contained the anti-Hu antibody. Chest film and CT of the chest showed enlarged mediastinal and hilar nodes. Mediastinoscopy revealed a focus of small cell lung cancer in one of the nodes. Treatment was undertaken. Neurological symptoms stabilized, but did not resolve.

Learn More >>