Paraneoplasdtic Syndromes

PARANEOPLASTIC NEUROLOGICAL SYNDROMES -- CLINICAL REFERENCE FOR NEUROLOGISTS AND ONCOLOGISTS A comprehensive, evidence-based clinical reference app for the diagnosis and management of paraneoplastic neurological syndromes (PNS), developed by Dr Atif Elnil MBBS MRCP, Neurology and Stroke Fellow. Based on Graus et al. (JNNP 2004 and updated 2021) diagnostic criteria, Honnorat and Antoine (Orphanet 2007), Dalmau and Rosenfeld (Lancet Neurology 2008), and Titulaer et al. (Lancet Oncology 2011) tumour screening evidence. DESIGNED FOR: Neurologists, oncologists, stroke physicians, rheumatologists, intensivists and specialist trainees managing patients with suspected or confirmed paraneoplastic neurological syndromes. KEY SECTIONS: DIAGNOSTIC APPROACH -- Graus 2021 updated diagnostic criteria: Definite, Probable and Possible PNS -- Step-by-step diagnostic workup: MRI, LP, antibody panels, electrophysiology, tumour screen -- PNS risk scoring: antibody type, syndrome, cancer risk factors -- Classic high-risk syndrome identification ANTIBODY PROFILES (19 tap-to-expand cards -- 3 tabs) -- Onconeural antibodies: Anti-Hu (SCLC), Anti-Yo (ovary/breast cerebellar), Anti-Ri (opsoclonus), Anti-Ma2 (testicular GCT, narcolepsy), Anti-CV2/CRMP5 (chorea), Anti-Amphiphysin (stiff person), Anti-SOX1 (SCLC marker), Anti-KLHL11 (rhombencephalitis) -- Cell-surface antibodies: Anti-VGCC (LEMS with amifampridine dosing), Anti-AChR/MuSK (myasthenia gravis), Anti-IgLON5 (sleep disorder, tauopathy), Anti-CASPR2 (Morvan syndrome) -- Quick reference table: all 15 major antibodies with tumour association, syndrome and immunotherapy response rating CLINICAL SYNDROMES (tap-to-expand cards) -- Paraneoplastic cerebellar degeneration (PCD): rapid progression, anti-Yo, MRI, FDG-PET -- Paraneoplastic limbic encephalitis (PLE): amnesia, seizures, onconeural vs cell-surface distinction -- Subacute sensory neuropathy: proprioceptive loss, pseudoathetosis, anti-Hu -- Opsoclonus-myoclonus-ataxia: anti-Ri, neuroblastoma in children -- Lambert-Eaton myasthenic syndrome (LEMS): EMG criteria, amifampridine dosing, SCLC screening -- Stiff person syndrome: anti-amphiphysin vs anti-GAD65, diazepam/baclofen dosing -- Paraneoplastic encephalomyelitis: multifocal, anti-Hu, SCLC TUMOUR SCREENING -- Antibody-specific tumour targets with colour-coded badges -- Mandatory first-line screen protocol: CT, pelvic imaging, testicular ultrasound, mammogram -- FDG-PET/CT guidance: when to use, 20% detection rate in CT-negative cases -- Repeat screening schedule: 3-6 months, 12 months, 2 years -- Neuroblastoma screening in children with opsoclonus-myoclonus DIFFERENTIAL DIAGNOSIS -- Cerebellar mimics: Wernicke, CJD, SCA, drug toxicity, Miller Fisher -- Limbic mimics: HSV, non-paraneoplastic AIE, CNS lymphoma -- Neuromuscular mimics: MG vs LEMS, CIDP, ALS, botulism -- VGKC-complex antibody clarification: clinical significance of LGI1/CASPR2 specificity REFERENCES (25+ citations) All content derived from: Graus F et al. JNNP 2004 and JNNP 2021 (diagnostic criteria) Honnorat J, Antoine JC. Orphanet 2007 Dalmau J, Rosenfeld MR. Lancet Neurology 2008 Titulaer MJ et al. Lancet Oncology 2011 Greenlee JE. Handbook of Clinical Neurology 2014 Vedeler CA et al. European Journal of Neurology 2006 And 19+ additional peer-reviewed publications FOR HEALTHCARE PROFESSIONALS ONLY This app is an educational reference tool for qualified healthcare professionals. It does not replace clinical assessment, specialist neurological review, or multidisciplinary oncology team input.