ABSTRACT
OBJECTIVE: To report an unusual paraneoplastic syndrome, amyotrophic lateral sclerosis, associated with renal cell carcinoma. CASE PRESENTATION AND INTERVENTION: A 59-year-old man presented with muscle weakness and fasciculations in the upper extremities. Neurological examination showed that the fasciculations arose spontaneously in the upper limbs. Electrodiagnostic studies revealed an active neurogenic disorder. The patient was diagnosed with a motor neuron disease mimicking amyotrophic lateral sclerosis. Urine analysis revealed microscopic hematuria. Abdominal computerized tomography scans showed a 9.5 x 8 cm renal mass in the lower pole of the right kidney. Curative right radical nephrectomy was performed. Pathologic examination showed a clear cell adenocarcinoma. After nephrectomy, the muscle weakness and fasciculations disappeared spontaneously within 2 months. The patient was disease-free for 58 months after right radical nephrectomy. He complained of muscle weakness and fasciculation at the last follow-up again. Physical examination revealed fasciculation in the upper limbs. Abdominal tomography showed a 22 x 20 mm solid mass in the lower pole of the left kidney. Kidney-saving surgery was performed and the diagnosis of renal cell carcinoma was confirmed pathologically. Following surgery, fasciculations completely disappeared and muscle weakness diminished within 3 months. CONCLUSION: This case highlights motor neuron disease as a rare paraneoplastic syndrome in association with renal cell carcinoma and resolution after removal of the tumor.
Subject(s)
Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/diagnosis , Motor Neuron Disease/etiology , Paraneoplastic Syndromes/etiology , Amyotrophic Lateral Sclerosis , Carcinoma, Renal Cell/surgery , Diagnosis, Differential , Humans , Male , Middle Aged , Nephrectomy , Treatment OutcomeABSTRACT
Power spectral analysis of heart rate variability (HRV) provides a non-invasive method of estimating cardiac autonomic nerve activity. It has been reported that HRV decreases with age. The purpose of this study was to assess the values of and determine the reliability of HRV in healthy older people. The study found lower and highly variable values of HRV. It was concluded that the reliability of HRV in older subjects might need to be reinvestigated and only normalized values of HF and LF might be useful. Larger study groups and different recording periods of HRV are needed.
