Postural hypotension, diminished reflexes, pupillary response sluggish (396/1700)

A 56 yo lady with lung cancer presents with urinary retention, postural hypotension, diminished
reflexes and sluggish papillary reaction. What is the most likely explanation for her symptoms?
a. Paraneoplastic syndrome
b. Progression of lung cancer
c. Brain metastasis
d. Hyponatremia
e. Spinal cord compression






























answer: A

Physical findings in patients with paraneoplastic autonomic failure resemble those of any patient with autonomic dysfunction and include the following:

• Orthostatic hypotension, often profound, in the absence of volume depletion
• Impaired pupillary light responses
• Absence of heart rate changes with respiration
• Abnormal Valsalva response
• Abnormal cold pressor response
• Dysrhythmias such as bradycardia, tachycardia, or asystole

Peripheral sensory neuronopathy often is evident as patchy superficial sensory loss and asymmetrically abnormal stretch reflexes.

Patchy asymmetric weakness and dyscoordination, or abnormal mental status, may occur in patients with CNS involvement.

Proximal muscle weakness is seen in LEMS.