Paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of literature

Abstract

Paraneoplastic cerebellar degeneration (PCD) is a rare complication of some malignant cancers caused by an autoimmune response against neuronal antigens expressed by tumor cells. It is most commonly described in women with gynecologic or breast cancer, however, there have been reports in other types of cancer. Symptoms include ataxia, dysarthria and tremors, which could be the first manifestations of an underlying malignancy. A 50-year-old woman had acute PCD with anti-Yo antibodies from an underlying invasive ovarian carcinoma. She developed speech dysfunction, asthenia and ataxia. Antineuronal antibody testing was positive only for anti-Yo. These findings were consistent with the diagnosis of pancerebellar degeneration. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days and 6 sessions of plasma exchange. After this treatment, the neurological examination was partly improved.
Paraneoplastic clinical syndromes affect <1% of patients with cancer; however, the frequency of subclinical levels of paraneoplastic autoantibodies in asymptomatic patients with cancer is unknown. Numerous studies have reported that ovarian cancer patients show signs of paraneoplastic neurological syndromes before or after their cancers are diagnosed. This case underlines the importance of early diagnosis, which can allow appropriate treatment that may stabilize the neurological symptoms.