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HIV-associated vacuolar myelopathy — SCE Neurology MCQ

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HardCNS InfectionsHIV-associated vacuolar myelopathySCE Neurology

A 67-year-old smoker develops a painful non-length-dependent sensory neuronopathy, autonomic dysfunction and anti-Hu antibodies. CT shows limited-stage small-cell lung cancer. Which statement best guides management and counselling?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Prioritise tumour treatment; neurological recovery from immunotherapy alone is usually limited

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

C is correct: anti-Hu syndromes are generally T-cell-driven and often cause irreversible neuronal loss, so early treatment of the underlying cancer offers the best chance of stabilisation; immunotherapy may be tried but expectations for neurological recovery should be guarded. A overstates IVIg responsiveness. B treats LEMS, not sensory ganglionopathy. D dangerously delays tumour control. E has no mechanistic role. The non-length-dependent pattern and reduced or absent sensory potentials localise to dorsal-root ganglia.

Reference: Paraneoplastic neurological syndromes: a practical approach to diagnosis and management: https://pn.bmj.com/content/22/1/19