Unusual Neurological Presentation in a Patient with Known Metastatic Prostate Cancer (P3.369)

We present the interesting case of a 71 year old gentleman, previously diagnosed with metastic prostate cancer, presenting with confusion and Abdominal pain. During his hospital admission he developed Renal Impairment and Spastic paraparesis with a sensory level up to T10 dermatome. Results of Investigations: A wide panel of investigations was performed. The most significant were: Creatinine 329umol/L, Hb 8.4g/dl, platelets 51,000, LDH 395,000. Blood film pointed towards a haemolytic state. MRI spine showed showed abnormal intramedullary T2 signal in the distal cord extends from T8/T9 disk space to the conus likely cord infarct or transverse myelitis. In addition he had stable bony me; MRI brain showed small vessel ischemic changes. CSF was normal. Blood tests were sent for vitamin B12 & Folic acid, ESR, Copper, C3/C4, TSH, ESR, CRP, HIV, Syphilis, Lyme disease, vasculitic screen include (ANA,ANCA and AntiGBM), NMO Abs and paraneoplastic screen and all the tests results were negative. Discussion: The unifying diagnosis for our patient's condition is Thrombotic Microangiopathy syndrome (TMA) -Thrombotic Thrombocytopenic Purpura (TTP). The underlying malignancy was the trigger for the syndrome. ADAMST 13 A was normal, which supports malignancy-associated TTP. He didn't respond to pulsed IV steroids but showed dramatic improvement to treatment with plasma exchange and Rituximab. Repeat MRI showed complete resolution. TMA-TTP is rare disease, many associated neurologica...
Source: Neurology - Category: Neurology Authors: Tags: General Neurology Source Type: research