SHM Converge Scientific Abstract ePoster Gallery-When the Work Up for Ataxia Falls Flat: Recognizing Paraneoplastic Cerebellar Degeneration

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This case report describes a 75-year-old woman with hypertension and hyperlipidemia who presented with one month of worsening gait imbalance, intermittent visual disturbances, absent vibration sense in both feet, brisk reflexes with bilateral upgoing toes, and marked gait instability. Initial neurologic workup, including CT head, MRI brain, and lumbar spine MRI, was unrevealing for a clear structural cause.<br /><br />Further evaluation showed inflammatory changes in the cerebrospinal fluid and a CT scan of the abdomen and pelvis revealing a 7.5-cm left pelvic mass suspicious for ovarian malignancy. Biopsy confirmed stage IIIC high-grade serous carcinoma of the left ovary and fallopian tube with metastases to the rectum, omentum, and cervical tissue. Immunohistochemistry was PAX8 positive with p53-null expression. An antibody panel was positive for anti-Yo antibodies, leading to the diagnosis of paraneoplastic syndrome secondary to ovarian carcinoma.<br /><br />The report emphasizes that paraneoplastic syndromes are immune-mediated conditions caused by a tumor’s hormonal or immune effects rather than direct invasion or metastasis. Although rare in ovarian cancer, they can present with neurological symptoms such as cerebellar degeneration, ataxia, and other neurologic deficits. In older women, especially those in their 50s to 70s, clinicians should consider breast or pelvic malignancies when unexplained cerebellar or gait symptoms persist after routine workup is negative.<br /><br />The discussion highlights the importance of early recognition, antibody testing (especially anti-Yo, Hu, Tr, Ri, and GluR1), tissue biopsy for diagnosis and staging, and prompt involvement of oncology and surgical teams. The key conclusion is that unexplained rapidly progressive ataxia in an older woman should prompt evaluation for paraneoplastic cerebellar degeneration, as early diagnosis may improve outcomes, though delayed presentation often leads to poor prognosis.

Asset Subtitle

Rajesh Metuku

Meta Tag

Author List Ardit Feinaj, Henry Ash, Jolian Rios, Omar Zuhdi, Rajesh Metuku

Category Clinical Vignettes

Concept Paraneoplastic Syndrome

Concept Paraneoplastic Cerebellar Degeneration

Concept Ataxia

Concept Disequilibrium

Concept Anti-Yo Antibodies

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health Medical Center

Presenting Author Rajesh Metuku

Track Adult

Keywords

paraneoplastic syndrome

ovarian carcinoma

anti-Yo antibodies

cerebellar degeneration

ataxia

gait imbalance

high-grade serous carcinoma

ovarian cancer

neurologic symptoms

paraneoplastic cerebellar degeneration

Paraneoplastic Syndrome

Paraneoplastic Cerebellar Degeneration

Ataxia

Disequilibrium

Anti-Yo Antibodies