Peripheral Neuropathies

Approximately 5 percent of cancer patients have clinical neuropathy, 12 percent have abnormalities on quantitative sensory testing, and 40 percent have electrophysiological abnormalities. y Typically, women with small cell lung or breast carcinoma present with asymmetrical upper limb pain, paresthesia, and sensory loss preceding the diagnosis of cancer. When proprioception is lost, pseudoathetosis occurs. Subacute sensory neuronopathy results from inflammation and degeneration of the dorsal root ganglion cells. A lymphocytic response gives way to fibrosis. The loss of the dorsal root cells is accompanied by marked secondary demyelinative changes in the dorsal columns and peripheral sensory nerves. y Damage to the dorsal root ganglion cell results in a sensory neuronopathy characterized by pain and sensory loss. The sensorimotor neuropathies may be acute, subacute, or relapsing. Acute neuropathy similar to acute inflammatory demyelinating polyneuropathy has been described with a number of malignancies, including Hodgkin's disease. y The origin of peripheral neuropathies in patients with cancer is often obscured by the peripheral neurotoxic effects of chemotherapeutic agents, metabolic disorders, and inactivity.

Stiff-person syndrome, characterized by muscle rigidity and painful spasms, has been described in association with breast cancer and autoantibodies against a 128-kd neuronal antigen concentrated at synapses and identified as amphiphysin. '73! , y

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