Öz
Neoplasm associated longitudinally extensive transverse myelitis (LETM) is mainly associated with solid tumors, especially lung and breast. This disease may present with different clinical, radiological and pathological features. It has severe disability and high mortality. A 44-year-old female patient presented with weakness in the lower extremities and urinary incontinence for 2 months. Paraparesis (right lower extremity 2/5 and left lower extremity4/5) was noted on the neurological examination. Hypoesthesia was detected under the T9 dermatomal level. Spinal magnetic resonance imaging showed hyperintensity consistent with long-segment myelitis of thoracic and lumbar spinal cord. On the second day of treatment, widespread abdominal pain started. It has been learned that these pain have been repeated for one year. Abdominal computed tomography revealed a 9x7.5 cm mass in the right ovary, aortic vascular invasion, hepatosplenomegaly and diffuse ascites. The result of salpingooferectomy was shown to be ovarian sarcoma with undifferentiated tumor. Spinal cord lesions resulting from neoplasm may present with different clinical symptoms. The most important prognostic factor is the type of primary tumor and metastasis. Therefore, early detection of the tumor is very important. The sensitivity of the screening tests is low. For this reason, clinical symptoms should be evaluated in detail.
Anahtar Kelimeler
Kaynakça
- 1. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology 2006;66:1485-9.
- 2. Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA. Transverse myelitis: pathogenesis, diagnosis and treatment. Front BioSci 2004;9:1483-99.
- 3. Cross SA, Salomao DR, Parisi JE, et al. Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. AnnNeurol 2003;54:38-50.
- 4. Pittock SJ, Lucchinetti CF, Parisi JE, et al. Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 2005;58:96-107.
- 5. Barnes G, Benjamin S, Bowen JD, et al. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002;59:499-505.
- 6. Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis. Semin Neurol 2008;28:105-20.
- 7. Kerr DA, Ayetey H. Immunopathogenesis of acute transverse myelitis. Curr Opin Neurol 2002;15:339-47.
- 8. Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturation disturbance in acute transverse myelitis. Spinal Cord 1996;34:481-5.
- 9. Kennedy PG, Weir AI. Rapid recovery of acute transverse myelitis treated with steroids. Postgrad Med J 1988;64:384-5.
- 10. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 2002;58:14-6.
- 11. Frasquet M, Bataller L, Torres-Vega E, et al. Longitudinally extensive transverse myelitis with AQP4 antibodies revealing ovarian teratoma. Journal of neuroimmunology 2013;263(1-2):145-7.
- 12. Flanagan EP, McKeon A, Lennon VA, et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology 2011;76:2089-95.
- 13. Papadopoulos MC, Verkman AS. Aquaporin 4 and neuromyelitis optica. Lancet Neurol. 2012;11:535-44.
Öz
Tümör ilişki longitudinal ekstensif transvers miyelit (LETM), başta akciğer ve meme olmak üzere özellikle solid tümörler ile ilişkilidir. Bu hastalık farklı klinik, radyolojik ve patolojik bulgular ile ortaya çıkabilir. Ciddi dizabilite ve yüksek mortaliteye sahiptir. 44 yaşında kadın hasta, 2 aydır olan alt ekstremitelerde güçsüzlük ve idrar inkontinansı nedeni ile başvurdu. Nörolojik muayenede paraparezi (sağ alt ekstremitede 2/5 ve sol alt ekstremitede 4/5) belirlendi. T9 dermatomal seviyenin altında hipoestezi saptandı. Spinal manyetik rezonans görüntülemede; torakal ve lomber spinal kord uzun segment, miyelit ile uyumlu hiperintensite mevcuttu. Tedavinin 2. günü yaygın karın ağrısı başladı. Bu ağrıların son 1 yıldır ara ara tekrarladığı öğrenildi. Abdomen bilgisayarlı tomografide; sağ overde 9x7.5 cm kitle, aortik vasküler invazyon, hepatosplenomegali ve yaygın asit belirlendi. Salpingooferektomi neticesinde elde edilen kitlenin indiferansiye ovarian sarkom olduğu anlaşıldı. Neoplazi sonucu oluşan spinal kord lezyonları farklı klinik bulgular ile ortaya çıkabilir. En önemli prognostik unsur, primer tümöral yapının tipi ve metastaz durumudur. Bu nedenle tümörün erken dönemde tespit edilmesi oldukça önemlidir. Tarama testlerinin duyarlılığı düşüktür. Bu nedenle klinik semptomlar ayrıntılı olarak değerlendirilmelidir.
Anahtar Kelimeler
Kaynakça
- 1. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology 2006;66:1485-9.
- 2. Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA. Transverse myelitis: pathogenesis, diagnosis and treatment. Front BioSci 2004;9:1483-99.
- 3. Cross SA, Salomao DR, Parisi JE, et al. Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. AnnNeurol 2003;54:38-50.
- 4. Pittock SJ, Lucchinetti CF, Parisi JE, et al. Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 2005;58:96-107.
- 5. Barnes G, Benjamin S, Bowen JD, et al. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002;59:499-505.
- 6. Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis. Semin Neurol 2008;28:105-20.
- 7. Kerr DA, Ayetey H. Immunopathogenesis of acute transverse myelitis. Curr Opin Neurol 2002;15:339-47.
- 8. Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturation disturbance in acute transverse myelitis. Spinal Cord 1996;34:481-5.
- 9. Kennedy PG, Weir AI. Rapid recovery of acute transverse myelitis treated with steroids. Postgrad Med J 1988;64:384-5.
- 10. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 2002;58:14-6.
- 11. Frasquet M, Bataller L, Torres-Vega E, et al. Longitudinally extensive transverse myelitis with AQP4 antibodies revealing ovarian teratoma. Journal of neuroimmunology 2013;263(1-2):145-7.
- 12. Flanagan EP, McKeon A, Lennon VA, et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology 2011;76:2089-95.
- 13. Papadopoulos MC, Verkman AS. Aquaporin 4 and neuromyelitis optica. Lancet Neurol. 2012;11:535-44.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Ocak 2020 |
| Kabul Tarihi | 23 Ekim 2018 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 21 Sayı: 1 |
Kaynak Göster
