Case Report
Paraneoplastic Adenocarcinoma Presenting as Bulbar-Predominant Motor Neuronopathy: A Reversible ALS Mimic in an Elderly Male
Fatema Arsiwala1, Akansha Joshi1*, Ashutosh Tiwari1, Aarohi Doshi2, Tushar Raut2 and Jyotsna Oak3
1Department of General Medicine, Kokilaben Dhirubhai Ambani Hospital, Andheri, Mumbai, Maharashtra, India
2Department of Neurology, Kokilaben Dhirubhai Ambani Hospital, Andheri, Mumbai Maharashtra, India
3Head of Department, General Medicine and Consultant Rheumatologist, Kokilaben Dhirubhai Ambani Hospital, Andheri, Mumbai, Maharashtra, India
2Department of Neurology, Kokilaben Dhirubhai Ambani Hospital, Andheri, Mumbai Maharashtra, India
3Head of Department, General Medicine and Consultant Rheumatologist, Kokilaben Dhirubhai Ambani Hospital, Andheri, Mumbai, Maharashtra, India
*Corresponding author:Akansha Joshi, Department of General Medicine, Kokilaben Dhirubhai Ambani Hospital Andheri, Mumbai, Maharashtra, India. E-mail Id: akankshajoshi710@gmail.com
Article Information:Submission: 07/02/2026; Accepted: 03/03/2026; Published: 05/03/2026
Copyright: © 2026 Arsiwala F, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background:Bulbar-onset amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder, characteristically non-reversible. In rare instances, paraneoplastic neurological syndromes (PNS) can present with ALS-like features. These immune-mediated conditions may show modest response to
immunotherapy but typically require tumor therapy for meaningful recovery.
Case Presentation:A 75-year-old man presented with two months of progressive dysphagia, muscular twitching of the tongue, and weakness. Neurophysiology confirmed motor neuronopathy. PET CT revealed a carotid bifurcation mass and hypermetabolic rectosigmoid thickening. Biopsy of a cervical lymph node demonstrated moderately differentiated adenocarcinoma. Intravenous corticosteroids resulted in only partial improvement, but subsequent targeted radiotherapy to the primary malignancy led to marked and sustained recovery of bulbar and motor function.
Conclusion:This case highlights the diagnostic importance of identifying paraneoplastic motor neuronopathies in atypical, rapidly progressive bulbar presentations. ALS mimics may respond incompletely to corticosteroids but show more substantial benefit with targeted oncologic treatment.
Case Presentation:A 75-year-old man presented with two months of progressive dysphagia, muscular twitching of the tongue, and weakness. Neurophysiology confirmed motor neuronopathy. PET CT revealed a carotid bifurcation mass and hypermetabolic rectosigmoid thickening. Biopsy of a cervical lymph node demonstrated moderately differentiated adenocarcinoma. Intravenous corticosteroids resulted in only partial improvement, but subsequent targeted radiotherapy to the primary malignancy led to marked and sustained recovery of bulbar and motor function.
Conclusion:This case highlights the diagnostic importance of identifying paraneoplastic motor neuronopathies in atypical, rapidly progressive bulbar presentations. ALS mimics may respond incompletely to corticosteroids but show more substantial benefit with targeted oncologic treatment.
Keywords:Amyotrophic Lateral Sclerosis; Paraneoplastic Neurological Syndrome; Motor Neuronopathy; Adenocarcinoma; Bulbar Dysfunction; Radiotherapy