Paraneoplastic cerebellar degeneration — SCE Neurology MCQ

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EasyNeuro-oncologyParaneoplastic cerebellar degenerationSCE Neurology

A 55-year-old man presented with subacute severe ataxia preceding diagnosis of ovarian cancer. On examination, there was nystagmus, dysarthria and limb ataxia. Initial investigations showed: MRI was initially normal; anti-Yo antibodies were positive. What is the most likely diagnosis?

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Correct answer: B — Paraneoplastic cerebellar degeneration

Paraneoplastic cerebellar degeneration is the best answer because the vignette describes Paraneoplastic cerebellar degeneration: rapid pancerebellar syndrome with anti-Yo suggests paraneoplastic cerebellar degeneration. Brain metastases is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Glioblastoma and Spinal cord compression from metastasis are less appropriate because they would require different localisation, timing or test findings; Limbic encephalitis from small-cell lung cancer would fit a different syndrome. Clinical pearl: stroke would be sudden and territorial rather than subacute progressive.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance