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• W641336286 abstract "OBJECTIVE: To present a case of anti-Ri antibody associated paraneoplastic brainstem and cerebellar dysfunction in a patient with undiagnosed small cell lung carcinoma.BACKGROUND: Anti-Ri antibody is often tested for, but rarely detected in the serum and cerebrospinal fluid (CSF) of patients suspected of having paraneoplastic disease. Early reports emphasized a clinical triad of opsoclonus, myoclonus and cerebellar ataxia. Since then a small but evolving body of literature has revealed greater variability in clinical presentation and patient outcomes.DESIGN/METHODS: Case report.RESULTS: A 64 year-old man with an 80 pack-year smoking history presented with double vision, frequent falls and unintentional weight loss. Neurological examination revealed a fourth nerve palsy, bilateral end-gaze nystagmus, limitations on upgaze and a wide-based, ataxic gait. Neither opsoclonus nor myoclonus was observed. Computer tomography (CT) and magnetic resonance imaging (MRI) were negative for infarct or other pathology. CSF sampling was notable for mildly elevated protein and lymphocyte predominant pleocytosis. Malignancy work-up was undertaken with positron emission tomography (PET). This revealed a single hypermetabolic paraesophageal lymph node. Biopsy provided the diagnosis of small cell lung carcinoma. Intravenous immunoglobulin was given empirically for suspected paraneoplastic disorder, but there was no improvement after five days. The patient’s gait worsened despite preserved leg strength. Cisplatin and etoposide were initiated and his neurological symptoms stabilized, but did not improve. Eventually, results of the paraneoplastic panel sent at presentation provided the diagnosis: abnormal levels of anti-Ri antibodies were detected in serum. Two months later, repeat CSF sampling was performed. Remarkably, this revealed both persistent anti-Ri antibodies as well as leptomeningeal carcinomatosis.CONCLUSIONS: As both the brainstem and cerebellum are targets in anti-Ri associated autoimmunity, patients can present with a variety of symptoms related to these structures. Our case adds to a small, but growing body of literature that reflects this variability. Disclosure: Dr. Yang has nothing to disclose. Dr. Shum has nothing to disclose. Dr. Haigentz has nothing to disclose. Dr. Mariuma has nothing to disclose. Dr. Suhrland has nothing to disclose. Dr. Maleki has nothing to disclose. Dr. Acevedo-Ramirez has nothing to disclose. Dr. Gulko has nothing to disclose. Dr. Farinhas has nothing to disclose. Dr. Welch has nothing to disclose." @default.
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• W641336286 date "2015-04-06" @default.
• W641336286 modified "2023-10-05" @default.
• W641336286 title "Anti-Ri antibody associated paraneoplastic brainstem and cerebellar dysfunction as the presenting sign of small cell lung carcinoma (P4.237)" @default.
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