J Korean Ophthalmol Soc.  2013 Oct;54(10):1630-1634.

A Case of Neuromyelitis Optica with Paraneoplastic Syndrome in Hepatocellular Carcinoma

• Kil HK
• Lee GE
• Hong HJ
• Park SJ
• Sin SK

Abstract

PURPOSE
We report a case of neuromyelitis optica (Devic's syndrome) with hepatocellular carcinoma.
CASE SUMMARY
A 70-year-old male with hepatocellular carcinoma presented with bilateral visual loss. A relative afferent pupillary defect was not observed in either eye due to bilateral mydriasis. On brain MRI, there was no specific finding, however, on spine MRI, multiple and severe myelopathies were observed. After high-dose methylprednisolone pulse therapy, the visual acuity was 0.03 in the right eye and counting fingers at 30 cm in the left eye.
CONCLUSIONS
We encountered a case of neuromyelitis optica involving bilateral optic neuropathy in hepatocelluar carcinoma. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing a systemic evaluation.

Keyword

Devic's syndrome; Hepatocellular carcinoma; Neuromyelitis optica; Optic neuritis

MeSH Terms

Aged
Brain
Carcinoma, Hepatocellular*
Eye
Fingers
Humans
Male
Methylprednisolone
Mydriasis
Neuromyelitis Optica*
Optic Nerve Diseases
Optic Neuritis
Paraneoplastic Syndromes*
Pupil Disorders
Spinal Cord Diseases
Spine
Visual Acuity
Methylprednisolone

Figure

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  Figure 1. Liver CT scan of the patient at the initial visit. About 5.3 × 5.0 cm-sized round mass in the left lobe of the liver (expanding nodular type).

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  Figure 2. Slit lamp photographs at the initial presentation. Both eyes show marked mydriasis.

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  Figure 3. Fundus photographs at the initial presentation. There are no specific abnormalities in the retina of both eyes.

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  Figure 4. Visual evoked potential (VEP) showing increased latency and decreased amplitude in his both eyes.

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  Figure 5. Phillips Gyroscan 1.5T whole spine MRI shows multifocal ill-defined central high signal intensities in the spinal cord, T2- weighted images, C3-4, T2-3, T5-6, T8 and T11 levels (black arrow).

Reference

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