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Novel brainstern syndrome associated with prostate carcinoma

Department of Neurology (Drs. Baloh, Cloughesy, and Merrill), UCLA Medical Center, Los Angeles, CA the Department of Neurology (Dr. DeRossett), Emory University School of Medicine, Atlanta, GA; the Departments of Neurology (Dr. Kuncl) and Ophthalmology (Dr. Miller), Johns Hopkins Medical Center, Baltimore, MD; and the Department of Neurology (Dr. Posner), Memorial Sloan-Kettering Cancer Center, New York, NY.

Two patients successfully treated for prostatic cancer developed a progressive neurologic syndrome beginning with loss of voluntary horizontal eye movements followed by severe, persistent muscle spasms of the face, jaw, and pharynx. Both had mild gait unsteadiness, and one exhibited facial and abdominal myoclonus. Extensive diagnostic studies, including MRIs of the brainstem (with and without contrast), were normal. CSF examination showed mild pleocytosis and elevated IgG. Quantitative eye movement recordings documented selective involvement of voluntary horizontal saccades with sparing of horizontal slow eye movements. Neither patient had antineuronal antibodies in the blood. Postmortem examination revealed perivascular chronic inflammatory cells and microglial infiltration of the pons and medulla. One patient also had perivascular infiltrates in both mesial temporal lobes. Neuronal loss was localized to the pontine tegmentum, the medullary sensory nuclei, and the cerebellum. Brainstem motor nuclei were preserved. The clinical and pathologic findings suggest an autoimmune process (probably paraneoplastic) with selective damage to a subpopulation of brainstem neurons critical for horizontal eye movements and recurrent inhibition of bulbar nuclei.

Address correspondence and reprint requests to Dr. Robert W. Baloh, Department of Neurology, Reed Neurological Research Center, UCLA School of Medicine, 710 Westwood Plaza, Los Angeles, CA 90024–1769.

Received March 18, 1993. Accepted for publication in final form June 2, 1993.

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				J R Berger, M Bensalem, and J Dalmau A brainstem paraneoplastic syndrome associated with prostate cancer J. Neurol. Neurosurg. Psychiatry, August 1, 2009; 80(8): 934 - 935. [Abstract] [Full Text] [PDF]