Paraneoplastic Cerebellar Syndrome Presented as Cerebellar Hypermetabolism in a Patient With Occult Breast Carcinoma

Abstract

A 47-year-old woman presented with an acute cerebellar syndrome. Neither cerebellar atrophy nor an infarction or tumor was shown on MRI. A diagnostic CT demonstrated enlarged axillary lymph nodes, but no primary tumor. Puncture of these nodes showed non-small cell carcinoma. 18 F-FDG PET/CT imaging was performed and suggested an occult breast carcinoma, which was confirmed by pathological examination. It also showed cerebellar hypermetabolism, consistent with a PCS (paraneoplastic cerebellar syndrome). This case shows that 18 F-FDG PET imaging may be of value in patients in which a PCS is considered clinically, particularly in patients suspicious for an occult malignancy.

18F-FDG PET and MRI Evaluation of Paraneoplastic Limbic Encephalitis

“…Different patterns of FDG uptake correlate with particular autoantibodies 14 . Some autoantibodies may even produce atypical cerebellar encephalitis with corresponding FDG uptake 15,16 . No large studies have yet examined such patterns for anti-Hu, an intracellular antibody, but increased uptake in a unilateral MTL is consistent with current literature reports.…”

“…14 Some autoantibodies may even produce atypical cerebellar encephalitis with corresponding FDG uptake. 15,16 No large studies have yet examined such patterns for anti-Hu, an intracellular antibody, but increased uptake in a unilateral MTL is consistent with current literature reports. Studies with larger series are needed to examine FDG uptake patterns of causative autoantibodies.…”

Cerebellar Hypermetabolism in a Hodgkin Lymphoma Leads to Diagnosis of Paucisymptomatic Cryptococcus neoformans Meningitis

“…The latter finding was unexpected, because the patient experienced no meningism nor neurological deficits, but mere episodical retro-ocular headache. To differentiate between malignant central nervous system (CNS) infiltration 1–7 and immune-mediated paraneoplastic subacute cerebellar degeneration, 8–10 subsequent investigation with MR and lumbar puncture was carried out. MR showed nonspecific cerebellar edema without substantial leptomeningeal enhancement.…”