Parkinson's Disease – Impulse Control Disorder — SCE Neurology MCQ

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HardMovement DisordersParkinson's Disease – Impulse Control DisorderSCE Neurology

A 64-year-old smoker develops painless bilateral visual loss over three weeks. Examination shows swollen optic discs, vitreous cells and retinal vascular leakage. MRI shows optic-nerve enhancement, and CT reveals a hilar mass. Which antibody would best unify the ocular and oncological findings?

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Correct answer: D — CRMP5/CV2 antibody

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

D is correct: CRMP5/CV2-associated paraneoplastic optic neuropathy, particularly with small-cell lung cancer, can combine optic-disc swelling with vitreous or retinal inflammation. AQP4 and MOG optic neuritis do not characteristically explain a smoking-related hilar malignancy with posterior uveitis. Recoverin causes cancer-associated retinopathy with photopsias, field constriction and extinguished electroretinography rather than inflammatory optic neuropathy. The inflammatory ocular clues make CRMP5 more specific than a generic paraneoplastic visual syndrome.

Reference: Paraneoplastic neurological syndromes: a practical approach: https://pn.bmj.com/content/22/1/19