PARANEOPLASTIC CEREBELLAR DEGENERATION AN D HODGKINS-DISEASE

History and clinical findings: A 30-year-old previously healthy man su ddenly developed double vision, unsteady gait and some difficulty in s peech articulation. Within 4 weeks he had become markedly ataxic, unab le to walk, stand or sit down unaided. Neurological examination indica ted a severe cerebellar syndrome. There were no other abnormal finding s on physical examination. Investigations: There was no pleocytosis an d no oligoclonal bands in cerebrospinal fluid (CSF). A test for anti-P urkinje cell antibodies was negative in both CSF and serum. Computed t omography and nuclear magnetic imaging (NMI) of the brain were normal. Treatment and course: As a para-or postinfectious or paraneoplastic p rocess was suspected. i.v. immunoglobulin and oral corticosteroids wer e administered, but without improvement. 13 month later, a mediastinal mass was noted on a chest radiogram. This led to the diagnosis of a s tage IA Hodgkin's disease. Retrospectively the cerebellar degeneration was most likely a paraneoplastic change related to the Hodgkin's dise ase. However, an independent second disease cannot be excluded. While the treatment of Hodgkin's disease was successful, the neurological sy mptoms remained unchanged. Severe cerebellar atrophy was demonstrated on NMI. Conclusion: In case of cerebellar atrophy of undetermined aeti ology a paraneoplastic cause should be considered and an underlying ma lignant disease looked for.