SHM Converge Scientific Abstract ePoster Gallery-Unmasking the Silent Hints: A Rare Case of Paraneoplastic Neurological Syndrome

Pdf Summary

This case describes a 57-year-old woman with two weeks of confusion, memory loss, falls, and episodic abnormal movements who had already visited the ED three times for the same symptoms. Initial evaluation showed mild hyponatremia, but brain CT and MRI were negative. Chest imaging, however, revealed a 5 cm right hilar mass and a small right lung nodule. She was admitted, treated empirically with ceftriaxone, but then worsened with severe hypercapnia and declining mental status, requiring intubation and ICU care.<br /><br />Further neurologic workup, including lumbar puncture and MRI brain with contrast, did not identify another cause. EEG showed concerning epileptiform discharges, prompting Neurocritical Care to add IV lacosamide and brivaracetam. Bronchoscopy with EBUS biopsy showed extrinsic compression of the right superior segment, and preliminary cytology was suspicious for small cell carcinoma with a high Ki-67 index. A paraneoplastic panel later returned positive for ANNA1 (anti-Hu) antibodies, supporting a diagnosis of paraneoplastic neurologic syndrome (PNS).<br /><br />The patient improved after high-dose IV hydrocortisone and IV immunoglobulin (1 g/kg for 3 days). She was eventually extubated and started on carboplatin and etoposide chemotherapy for presumed small cell lung cancer.<br /><br />The case highlights that PNS is often missed because symptoms are nonspecific and may precede cancer diagnosis. Recognizing associated antibodies such as anti-Hu is important because early treatment of the underlying malignancy can improve neurologic and oncologic outcomes. In small cell lung cancer, PNS occurs in a minority of patients, but timely chemotherapy is associated with stabilization or improvement in many cases.

Asset Subtitle

Mallika Gyawali

Meta Tag

Author List Glenn Pottmeyer, Mallika Gyawali, Patricia Rich

Category Clinical Vignettes

Concept Paraneoplastic Neurologic Syndrome

Concept Small Cell Lung Carcinoma

Concept Anti-Hu Antibody

Concept Confusion

Concept Abnormal Movement

Distinguished Non-Finalist

Presenter Organization Parkview Health

Presenting Author Mallika Gyawali

Track Adult

Keywords

paraneoplastic neurologic syndrome

anti-Hu antibodies

small cell lung cancer

confusion

memory loss

hypercapnia

EEG epileptiform discharges

bronchoscopy EBUS

IVIG treatment

carboplatin etoposide

Paraneoplastic Neurologic Syndrome

Small Cell Lung Carcinoma

Anti-Hu Antibody

Confusion

Abnormal Movement