Abstract Details

Title Autoimmune Cerebellar Ataxia with P/Q-VGCC Antibodies in a Patient with Repetitive COVID-19 Infections

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 063

Objective To describe a rare case of cerebellar ataxia associated with autoantibodies against the voltage-gated calcium channel P/Q type in the setting of repetitive COVID-19 infections.

Background

Cerebellar ataxias are a group of disorders characterized by impaired coordination due to dysfunction of the cerebellum. They can arise from genetic or non-genetic etiologies, including toxic, infectious, nutritional, and autoimmune causes. Here, we present a case of autoimmune cerebellar ataxia in an adult patient with multiple COVID-19 infections.

Design/Methods N/A

Results A 63-year-old male with PMH of COPD presented with gait imbalance, dizziness, and falls. His symptoms started acutely one year ago during a confirmed COVID-19 infection, that was treated with steroids and antibiotics resulting in improvement of his respiratory symptoms, but no his neurological symptoms. His gait and balance symptoms progressively worsened, requiring the use of a cane to walk. He denied any vertigo, dysarthria, dysphagia, or diplopia. He had two additional COVID-19 infections with further worsening of his symptoms, Since the beginning of the pandemic he had 10 confirmed COVID-19 infections. Physical examination was unremarkable. Neurological exam was notable for an action tremor, central and appendicular ataxia, dysdiadochokinesia, dysmetria with finger-to-nose and heel-to-shin testing. He was unable to walk unassisted, had a wide-based gait, altered heel, toe, and tandem walking. Extensive laboratory examinations were unremarkable for toxic, infectious, and nutritional causes. Lumbar puncture revealed normal glycorrhaquia without pleocytosis but with an elevated protein level. CSF autoimmune panel was negative but paraneoplastic panel demonstrated antibodies against P/Q Type calcium channel. Brain MRI was normal. The patient was diagnosed with autoimmune cerebellar ataxia and treated with IVIG and physical therapy, resulting in significant symptom improvement including resolution of the tremor, and improved dysmetria and gait, enabling unassisted walking.

Conclusions Acute postinfectious cerebellar ataxias can evolve into chronic conditions due to the development of autoantibodies against neuronal proteins.

Authors/Disclosures
Alexander Carvajal- Gonzalez, MD, PhD (Harvard University) PRESENTER	Dr. Carvajal- Gonzalez has nothing to disclose.
Octavio Arevalo	No disclosure on file
J. D. Jordan, MD, PhD (University of Arizona)	Dr. Jordan has nothing to disclose.

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