# Paraneoplastic Central and Peripheral Demyelination Secondary to Oesophagus Malignancy: A Case Report

## TL;DR

A man with oesophageal cancer developed neurological symptoms due to paraneoplastic demyelination, showing the need to screen for cancer in unresponsive demyelinating cases.

## Contribution

Reports a rare case of simultaneous central and peripheral demyelination as a paraneoplastic syndrome linked to oesophageal malignancy.

## Key findings

- Nerve conduction and MRI revealed demyelination in both central and peripheral nervous systems.
- Immunotherapy failed, but cancer was detected via PET-CT and biopsy.
- The case emphasizes the importance of malignancy screening in resistant demyelinating syndromes.

## Abstract

A man in his 60s presented with subacute weakness of his lower limbs, numbness, and urinary retention, preceded by fever a few weeks back. Nerve conduction studies showed demyelinating parameters, and magnetic resonance imaging showed long-segment cord T2/STIR hyperintensities and multifocal lesions in the brain. CSF showed albuminocytologic dissociation. Despite immunotherapy with intravenous immunoglobulin (IVIg), symptoms progressed. A PET-CT scan revealed thoracic oesophageal malignancy with lymphatic spread, confirmed on biopsy as an undifferentiated carcinoma. The case was diagnosed as paraneoplastic demyelination involving both the central and peripheral nervous systems. The patient later developed pulmonary thromboembolism. This case highlights simultaneous central and peripheral demyelination as a paraneoplastic manifestation and underscores the need for malignancy screening in demyelinating syndromes unresponsive to standard immunotherapies.