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Anti Ma2-associated myeloradiculopathy: expanding the phenotype of anti-Ma2 associated paraneoplastic syndromes

Anti-Ma2 associated paraneoplastic syndrome usually presents as limbic encephalitis in association with testicular tumours.1 2 Only four patients have been reported with involvement outside the CNS, two of whom also had limbic or brainstem encephalitis.2 3 We report a man with anti-Ma2 associated myeloradiculopathy and previous testicular cancer whose neurological syndrome stabilised and anti-Ma2 titres fell following orchidectomy of a microscopically normal testis.

A 46-year-old dentist noticed weakness of pincer movement in the left hand. Six weeks later he developed sequential finger drop of the 4th, 5th and 3rd fingers of the left hand over days. During the subsequent weeks the fingers of his right hand also dropped. He had a prior history of left orchidectomy for stage I testicular seminoma and had been well on surveillance for 5 years. MRI brain, cervical spine and brachial plexii were normal. A diagnosis of multifocal motor neuropathy with conduction block was considered. Neurophysiology of the upper limbs demonstrated reduced motor amplitudes and acute and chronic denervation but no conduction block. Neurophysiology of the lower limbs was normal. He was given a trial of intravenous immunoglobulin without response. Some weeks later he developed an unusual itchy sensation spreading across his back and shoulders.

On examination there was head drop with weakness of neck flexion. There was wasting of both forearms and intrinsic hand muscles, with some fasciculations in the biceps and triceps. Tone was normal. There was asymmetric patchy proximal and distal weakness of both arms with finger drop. Reflexes were brisk …