Paraneoplastic optic neuritis and encephalomyelitis. Report of a case
D. Boghen, M. Sebag and J. Michaud
Neurology Service, Hotel-Dieu de Montreal, Quebec, Canada.
A 63-year-old man developed bilateral paresis of horizontal and upward eye
movements. He was found to have a small oat cell carcinoma of the lung.
Four months later he experienced acute visual blurring on the right side.
Examination of the right eye at that time revealed a visual acuity of 3/200
and a central scotoma. There was swelling of the right optic disc. Three
weeks after the onset of the visual loss, the acuity of the right eye
spontaneously improved to 20/60, the field deficit lessened, and there was
a decrease in the swelling of the optic disc. Subsequently, his
neuro-ophthalmologic condition remained unchanged but his general health
deteriorated, and he died nine months after the onset of the disease.
Neuropathologic examination showed mild perivascular lymphocytic
infiltration and fibrosis of the meninges throughout the central nervous
system, loss of neurons and gliosis in the third and fourth cranial nerve
nuclei, perivascular inflammation and gliosis of the optic nerves, and
chiasm and central demyelination of the right optic nerve. No tumor cells
were seen. These findings were consistent with a diagnosis of
paraneoplastic optic neuritis and paraneoplastic encephalomyelitis. The
present case confirms the existence of paraneoplastic optic neuritis and
illustrates the clinical course of the disease.
