Walsh & Hoyt: Chronic Progressive Sensorimotor Neuropathy

This paraneoplastic peripheral neuropathy is actually a heterogeneous group of conditions whose common clinical feature includes a relentless course of progressive loss of motor and sensory function over many months or even years. The clinical manifestations are nonspecific but reflect injury of peripheral motor and sensory nerves. They include progressive weakness, loss of muscle stretch reflexes, muscle atrophy, and progressive loss of sensation that is symmetric in the extremities but worse in the lower than in the upper limbs, and worse distally than proximally. Cranial nerve dysfunction is extremely uncommon. The clinical, electrophysiologic, and pathologic features usually reflect an underlying axonal-loss neuropathy but may in any one individual patient fulfill features of an axonal neuropathy, demyelinating neuropathy, or of mononeuritis multiplex associated with vasculitis of the vasa nervorum. Many of these neuropathies are thought to result from nutritional deficiencies or the cachectic state induced by the neoplasm.