Khealani B A, Qureshi R, Wasay M.
Motor neuronopathy associated with adenocarcinoma of esophagus.
J Pak Med Assoc Jan ;54(3):165-6.

A 57-year old man, smoker, presented with a 2months history of progressive walking difficulty. He was emaciated and his neurological examination was significant for absent gag reflex, mild proximal limb weakness (power of 4/5 on MRC scale), impaired proprioception and ataxic gait. Chest, abdominal and cardiovascular examination was normal. There was no lymphadenopathy. His complete blood counts, serum electrolytes, liver function tests, CPK were normal. Motor nerve conduction studies of right median, ulnar, posterior tibial and peroneal nerves revealed mildly slow conduction velocities. However, there was no conduction block. Sensory nerve conduction studies of bilateral sural, right median and right ulnar nerves were normal. The EMG findings were suggestive of anterior horn cell disorder (motor neuronopathy). He developed complaints of dysphagia. An upper GI endoscopy revealed a fungating and ulcerated growth at distal esophagus, confirmed on histopathology to be large cell adenocarcinoma. Later patient developed mental status changes and blindness. MRI brain showed multiple hemorrhagic metastasis to bone (sternum). An esophageal stent was placed and patient was managed conservatively. Later he developed recurrent pneumonia and died two months after the initial presentation.

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