Tumors masquerading as neurological diseases: A caution for clinicians in planning diagnosis and treatment

Neurol India. 2020 Mar-Apr;68(2):368-372. doi: 10.4103/0028-3886.280647.


Introduction: Neurological diseases can be due to direct diseases of the central nervous system (CNS) or peripheral nervous system (PNS) or be a bystander syndrome of systemic diseases. Treatment options depend on the cause. Toxic, metabolic and nutritional, and immune-mediated consequences of clinically occult neoplasms produce a spectrum of neurological diseases, recognition of which has therapeutic and prognostic importance.

Patients and methods: Children, as well as adults who presented to the authors in the last 5 years with neurological diseases and later their diseases could be diagnosed or attributed to neoplasms which were occult, were included for the study.

Observation: 28 patients were seen by the authors in the last 5 years with neurological manifestation and hidden tumor. Maximum incidence was in the age of above 60 years followed by the age group of 21-40 years. The commonest neurological presentation was muscle and nerve in adults and seizure in children.

Discussion: Short duration, rapid progression, severe weight loss, and poor response to treatment given for nontumor associated neurological syndrome are the red flags which point to the diagnosis.

Conclusion: Seizures and psychosis formed the commonest features in children, muscle and nerve in adults. Short duration, rapid progression, and resistance to treatment are the markers for possible underlying neoplasm.

Keywords: Mass lesions; TRIAD; prognostic and therapeutic relevance; treatment-resistant neurology.

MeSH terms

  • Adenoma / diagnosis
  • Adolescent
  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis
  • Ataxia / diagnosis
  • Carcinoma / diagnosis
  • Child
  • Dementia / diagnosis
  • Diagnosis, Differential*
  • Diagnostic Errors*
  • Female
  • Ganglioneuroma / diagnosis
  • Humans
  • Hypokalemic Periodic Paralysis / diagnosis
  • Lipoma / diagnosis
  • Lymphoma, Non-Hodgkin / diagnosis
  • MERRF Syndrome / diagnosis
  • Male
  • Middle Aged
  • Myoclonic Epilepsy, Juvenile / diagnosis
  • Neoplasms / diagnosis*
  • Nervous System Diseases / diagnosis*
  • Neuroblastoma / diagnosis
  • Opsoclonus-Myoclonus Syndrome / diagnosis
  • Ovarian Neoplasms / diagnosis
  • POEMS Syndrome / diagnosis
  • Pancreatic Neoplasms / diagnosis
  • Paraneoplastic Syndromes, Nervous System / diagnosis*
  • Parathyroid Neoplasms / diagnosis
  • Parkinsonian Disorders / diagnosis
  • Plasmacytoma / diagnosis
  • Polymyositis / diagnosis
  • Stomach Neoplasms / diagnosis
  • Subacute Combined Degeneration / diagnosis
  • Teratoma / diagnosis
  • Thymus Neoplasms / diagnosis
  • Young Adult