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Paraneoplastic cerebellar degeneration — SCE Neurology MCQ

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HardNeuro-oncologyParaneoplastic cerebellar degenerationSCE Neurology

A 61-year-old woman develops subacute gait ataxia, dysarthria and oscillopsia over 6 weeks. MRI brain is initially normal. CSF has lymphocytic pleocytosis and oligoclonal bands. Anti-Yo antibodies are positive and mammography shows an occult breast lesion. What is the most likely diagnosis?

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Correct answer: D — Paraneoplastic cerebellar degeneration

Paraneoplastic cerebellar degeneration is the best answer. Subacute pancerebellar syndrome with inflammatory CSF, anti-Yo antibodies and breast malignancy indicates paraneoplastic cerebellar degeneration. Alcoholic degeneration is chronic and vermian; MSA has autonomic/parkinsonian features; infarction is acute and focal; Friedreich ataxia starts earlier with sensory/cardiac features. Clinical pearl: MRI may be normal early despite severe immune-mediated cerebellar dysfunction.

Reference: EAN paraneoplastic neurological syndrome criteria; NICE suspected cancer guidance