Paraneoplastic cerebellar degeneration (PCD) is a rare presentation of tumor immune-mediated cerebellar ataxias (1), (2), (3). PCD often occurs with breast and gynecologic cancer (anti-Yo and anti-Ri antibodies), small cell lung cancer (anti-Hu and anti-CV2/ collapsin response-mediator protein 5 [CRMP5]), and Hodgkin’s lymphoma (anti-Tr antibodies) (4). A 45-year-old female with PCD developed worsening gait impairment and increased cerebellar perfusion on brain single photon emission computed tomography (SPECT) (Figure 1A). The anti-Yo antibody was present in the cerebrospinal fluid. Left breast cancer was subclinical on mammography (Figure 1B); however, it was detected via dedicated breast positron emission tomography (dbPET) (Figure 1C). She underwent a mastectomy and was diagnosed with invasive ductal carcinoma with an invasive diameter of 3 mm. The intensity of cerebellar hypermetabolism decreased on brain SPECT a week post-surgery (Figure 1D). She remained symptomatic without further progression. Patients with PCD symptoms and specific antibodies require appropriate diagnostic evaluation to identify the underlying cause.
Figure 1.
(A) Brain single photon emission computed tomography (SPECT) presented increased cerebellar perfusion (left: coronal; right: sagittal). (B) Mammography did not detect abnormalities. (C) Dedicated breast positron emission tomography presented an abnormal 18F-fluorodeoxyglucose uptake in the left breast. (D) Brain SPECT showed a decreased intensity of cerebellar hypermetabolism one week after surgery.
Article Information
Author Contributions
All the authors cared for the patient. Shinsuke Sasada drafted the manuscript, and Ayumi Kawamata approved the final version of the manuscript.
Conflicts of Interest
None
Approval by Institutional Review Board (IRB)
IRB approval was not required for this study.
Informed Consent
Informed consent was obtained from the patient.
References
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