
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38171858
10.2169/internalmedicine.2369-23
Pictures in Clinical Medicine
Bilateral Thalamic Lesions Associated with Lung Cancer
Mano Tomoo 12
Shimizu Hisao 1
1 Department of Neurology, Nara Prefecture General Medical Center, Japan
2 Department of Neurology, Nara Medical University, Japan
Correspondence to Dr.　Tomoo Mano, manoneuro@naramed-u.ac.jp

2 1 2024
15 8 2024
63 16 23412342
31 5 2023
21 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
bilateral thalamic lesions
lung cancer
paraneoplastic syndrome
==== Body
pmcAn 80-year-old man with stage IIIB small-cell lung cancer presented with asymptomatic bilateral thalamic lesions on magnetic resonance imaging (MRI) (Picture, B, arrow in A). T1-weighted imaging showed no lesions or contrast enhancement. He developed negative myoclonus-like involuntary movements (IVMs) in all four extremities, involving spontaneous and intermittent loss of muscular postural tone. Diffusion-weighted imaging showed significant changes (Picture). Elevated plasma pro-gastrin-releasing peptide levels prompted carboplatin and etoposide treatment, resulting in lesion improvement and IVM disappearance (Picture D, E). One month after chemotherapy discontinuation, IVMs with gait instability recurred, and MRI showed lesion exacerbation, possibly suggesting inflammation or edema (Picture F, G). MRI showed no change two months later. Electroencephalography and cerebrospinal fluid analyses were normal, with no fluctuations in consciousness or cognitive dysfunction. Despite the absence of antibodies associated with paraneoplastic syndromes, the temporal relationship between the evolution of MRI lesions and IVMs, response to chemotherapy, and tumor markers indicated paraneoplastic syndrome (1,2).

Picture.

The authors state that they have no Conflict of Interest (COI).

Acknowledgement

We thank the dedicated staff of the Department of Neurology at Nara Prefecture General Medical Center for their valuable contributions.
==== Refs
1. Smith AB , Smirniotopoulos JG , Rushing EJ , Goldstein SJ . Bilateral thalamic lesions. Am J Roentgenol 192 : 53-62, 2009.
2. Gupta N , Pandey S . Post-thalamic stroke movement disorders: a systematic review. Eur Neurol 79 : 303-314, 2018.29870983
