SHM Converge Scientific Abstract ePoster Gallery-Paraneoplastic Cerebellar Degeneration as a Result of an Ovarian Malignancy

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A 59-year-old woman with no significant medical history was admitted for worsening dizziness, vertigo, and diplopia. Exam showed severe right-sided nystagmus, mild limb weakness, and delayed coordination, but initial CT and MRI of the brain were normal. Workup revealed mild leukocytosis and, on CT of the chest/abdomen/pelvis, significant retroperitoneal lymphadenopathy suspicious for metastatic disease. Biopsy of a lymph node showed metastatic adenocarcinoma of gynecologic origin.<br /><br />Because her neurologic symptoms were out of proportion to the imaging findings, lumbar puncture and CSF testing were performed and revealed PCA-1 (anti-Yo) antibodies, consistent with paraneoplastic cerebellar degeneration. She was treated with high-dose steroids followed by intravenous immunoglobulin (IVIG). Further gynecologic oncology evaluation led to robotic total hysterectomy with bilateral salpingo-oophorectomy, which identified an invasive high-grade serous carcinoma arising from the left fallopian tube. Omentum was benign and there was no peritoneal disease.<br /><br />The patient was discharged to begin outpatient chemotherapy with carboplatin and paclitaxel.<br /><br />This case highlights that paraneoplastic neurologic syndromes, including paraneoplastic cerebellar degeneration, may present before the underlying malignancy is diagnosed. In middle-aged women with acute or progressive vertigo, diplopia, and cerebellar signs, occult gynecologic cancer should be considered even when brain imaging is unrevealing. Early recognition of anti-Yo/PCA-1–associated disease can accelerate cancer diagnosis and treatment.

Asset Subtitle

Paloma B. Alvarez Cordoliani

Meta Tag

Author List Joanne Zhu, Paloma B. Alvarez Cordoliani

Category Clinical Vignettes

Concept Paraneoplastic Cerebellar Degeneration

Concept Occult Neoplasia

Concept PCA-1 Antibody

Concept Vertigo

Concept Dizziness

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Regional Medical Center

Presenting Author Paloma B. Alvarez Cordoliani

Track Adult

Keywords

paraneoplastic cerebellar degeneration

anti-Yo antibodies

PCA-1

fallopian tube carcinoma

high-grade serous carcinoma

gynecologic malignancy

vertigo

diplopia

retroperitoneal lymphadenopathy

intravenous immunoglobulin

Paraneoplastic Cerebellar Degeneration

Occult Neoplasia

PCA-1 Antibody

Vertigo

Dizziness