Neurological manifestations of systemic disease and paraneoplastic syndromes
Paraneoplastic syndromes by the Graus 2021 criteria (high-risk phenotypes, antibody risk groups, tumour screening), checkpoint inhibitor neurotoxicity, and the neurology of diabetes, thyroid, liver, kidney, connective tissue disease, sarcoid and deficiency states.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Systemic disease reaches every level of the nervous system. Ask what level (brain, cord, root, nerve, junction, muscle), then what tempo, then which systemic process fits both.
- Paraneoplastic neurological syndromes (PNS) are immune attacks triggered by a tumour expressing neuronal antigens. Fewer than 1% of cancer patients get one, but in about two thirds the syndrome comes before the cancer diagnosis.
- The Graus 2021 criteria replaced "classical syndromes" and "well-characterised antibodies" with high-risk phenotypes, antibody risk groups and the PNS-Care score.
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Sources
- Updated diagnostic criteria for paraneoplastic neurologic syndromesGraus F et al., Neurology Neuroimmunology & Neuroinflammation 2021;8(4):e1014, 2021
- A clinical approach to diagnosis of autoimmune encephalitisGraus F et al., Lancet Neurology 2016;15(4):391-404, 2016
- Screening for tumours in paraneoplastic syndromes: report of an EFNS task forceTitulaer MJ et al., European Journal of Neurology 2011;18(1):19-e3, 2011
- Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline updateSchneider BJ et al., Journal of Clinical Oncology 2021;39(36):4073-4126, 2021
- eviQ: immune-related adverse events and oncological emergenciesAU/NZCancer Institute NSW
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- Last updated
- 14 November 2026
What changed
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