Where the Cord Ends and Nerves Begin: Anti-amphiphysin-associated Paraneoplastic Myeloradiculoneuropathy
FNU Rashna1, Anum Naz1, Sumera Rafat1, Sidra Jazil Faruqi1, Arooba Iqbal2, Tahreem Sajjad1, Qamar un Nisa1
1Dow University of Health Sciences Karachi, 2Lincoln Medical Center
Objective:
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Background:

Paraneoplastic syndromes can impact the neuro-axis, depending on the type of malignancies and the associated antibodies. In some instances, it can affect both central and peripheral nervous system. In our case, a patient who tested positive for anti-amphyphysin antibodies presented with conus medullaris syndrome, cauda equina syndrome, and peripheral neuropathy. This presentation is a rare occurrence.

Case presentation: A 47-year-old-male came with a one month history of gradually progressive bilateral lower limb numbness and paresthesias, starting in the feet and ascending to the knees, worsened by cold exposure. After one month, he acutely developed urinary retention, perineal burning, and rapidly progressive bilateral symmetrical lower limb weakness within a day, along with painful calf spasms triggered by movement and cold,leading him bedbound. Upper limbs remained unaffected, with no history of trauma, backache, radiating pain, seizures, cranial nerve, systemic involvement ,no prior episodes. On examination, there was reduced bulk and spastic tone in both lower limbs with 0/5 powers, absent ankle reflexes, and extensor plantar responses, saddle anesthesia and decreased pin prick upto knees bilaterally. MRI Spine showed a T2 hyperintense lesion from T11- L1. CSF revealed raised protein with lymphocytosis. Electrophysiology confirmed motor axonal neuropathy. Paraneoplastic panel was positive for anti-amphiphysin antibodies. CT Chest, Abdomen And Pelvis along with tumor markers were negative.Diagnosed as paraneoplastic myeloradiculoneurpathy, patient improved with steroids and plasmapheresis and remains on azathioprine with ongoing surveillance.


Design/Methods:
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Results:
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Conclusions:
This case highlights the importance of combined CNS and PNS involvement as a clue to autoimmune myeloradiculoneuropathy. The presence of upper and lower motor neuron signs is often interpreted as motor neuron disease but thorough workup should prompt consideration of a paraneoplastic etiology, even in the absence of detectable malignancy. Early immunotherapy can lead to clinical improvement, while continued follow up and surveillance remains essential for underlying cancer detection.
Generative AI Usage
Yes, used generative AI in the drafting or editing in this abstract.

Tool, version, and prompt(s) used, as well as area of the abstract affected
Chat GPT 2.0 and prompt i used( my patient is diagnosed as myeloradiculoneuropathy and anti amphiphysin antibodies is positive , suggest me title for abstract submission). i have asked for title ideas.
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