Paraneoplastic Cerebellar Degeneration

Consequential

Step 1: View clinicals

A 55 year old lady complains of worsening dizziness and diplopia for the last 3 weeks, and now is unable to walk steadily. There is no history of trauma, fever, or constitutional symptoms. Her medical history is unremarkable and she is not on any medications. Both her mother and a maternal aunt were diagnosed with unilateral ovarian malignancies in their mid-50s. Her diet is balanced, and she does not drink, smoke or use recreational drugs.


Step 2: Order all relevant investigations

Contrast MRI Brain

The MRI scan of the brain is completely normal.

Antineuronal Antibodies

Anti-Yo: positive Anti-Hu: negative.

CT Abdomen & Pelvis

There is a 3.5 x 3 cm multicystic mass involving the right ovary, with thick walls and multiple septae and papillary projections. The liver, spleen and kidneys appear normal. There is no evidence of tumorous deposits involving the pelvic walls, peritoneum or other organs. No free fluid is present.

Audiometry

Pure tone audiometry of both ears only shows mild age related hearing loss.


Step 3: Select appropriate management

Oncology Referral
Diagnostic Laparoscopy
Plasmapheresis
Cyclophosphamide


Score: ★★☆