eMedicine Specialties > Neurology > Neuro-oncology

Paraneoplastic Encephalomyelitis: Follow-up

Author: David S Liebeskind, MD, Associate Professor of Neurology, Program Director, Vascular Neurology Residency Program, University of California at Los Angeles; Neurology Director, Stroke Imaging Program, Co-Medical Director, Cerebral Blood Flow Laboratory, Associate Neurology Director, UCLA Stroke Center
Contributor Information and Disclosures

Updated: Jun 11, 2009

Follow-up

Further Inpatient Care

  • Physical therapy
  • Nutritional assessment

Further Outpatient Care

  • Physical therapy

Inpatient & Outpatient Medications

  • Immunosuppressive medications
  • Anticonvulsants

Transfer

Rapid diagnosis of paraneoplastic encephalomyelitis (PEM) and evaluation of an underlying malignancy should be conducted at a center with neurologic expertise and diagnostic neuroradiologic modalities available.

Deterrence/Prevention

Preventive measures, such as smoking cessation, are focused on reducing the incidence of the associated malignancy.

Complications

  • Severe neurologic disability or death
  • Infections
  • Deep venous thrombosis

Prognosis

The clinical course of PEM is unpredictable, although the titer of anti-Hu antibodies has been suggested as a prognostic indicator. Elevated titers have been associated with worse neurologic outcome and death.

Patient Education

Public education efforts should emphasize the dangers of smoking and increase awareness of paraneoplastic disorders.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose a paraneoplastic neurologic syndrome.
  • Failure to pursue a comprehensive search for an underlying malignancy once the diagnosis of a paraneoplastic syndrome has been established.
 


More on Paraneoplastic Encephalomyelitis

Overview: Paraneoplastic Encephalomyelitis
Differential Diagnoses & Workup: Paraneoplastic Encephalomyelitis
Treatment & Medication: Paraneoplastic Encephalomyelitis
Follow-up: Paraneoplastic Encephalomyelitis
Multimedia: Paraneoplastic Encephalomyelitis
References
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Further Reading

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Keywords

anti-Hu syndrome, anti-Hu–associated paraneoplastic encephalomyelitis, paraneoplastic limbic encephalitis, paraneoplastic limbic encephalopathy, paraneoplastic brainstem encephalopathy, paraneoplastic myelopathy, subacute sensory neuronopathy, SSN, paraneoplastic ganglioradiculoneuritis, paraneoplastic sensory neuropathy, paraneoplastic encephalomyelitis, PEM, multifocal inflammatory CNS disorder

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Contributor Information and Disclosures

Author

David S Liebeskind, MD, Associate Professor of Neurology, Program Director, Vascular Neurology Residency Program, University of California at Los Angeles; Neurology Director, Stroke Imaging Program, Co-Medical Director, Cerebral Blood Flow Laboratory, Associate Neurology Director, UCLA Stroke Center
David S Liebeskind, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Society of Neuroimaging, American Society of Neuroradiology, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Medical Editor

Frederick M Vincent Sr, MD, Clinical Professor, Department of Neurology and Ophthalmology, Michigan State University Colleges of Human and Osteopathic Medicine
Frederick M Vincent Sr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Legal Medicine, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

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