Abstract Details

Title Reversible Cerebellar Ataxia Due to Ovarian Teratoma

Topic Movement Disorders

Presentation(s) (-)

Poster/Presentation
Number 008

Objective

Background Cerebellar dysfunction is a common paraneoplastic syndrome associated with gynecological and breast tumors, small-cell lung cancer and Hodgkin's lymphoma. We present the case of a 22-year-old woman with acute cerebellar ataxia that subsided upon removal of an ovarian teratoma.

Design/Methods

Results The patient presented with acute vertigo, vomiting, oscillopsia and dysarthria. Her initial exam was notable for nystagmus, titubation, limb ataxia and dysmetria. Her gait was severely ataxic, requiring full assistance to stand and walk. A lumbar puncture demonstrated a lymphocytic pleocytosis and a slight increase in her immunoglobulin G. Brain magnetic resonance (MR) imaging and MR angiography were unrevealing. Laboratory tests including cerebrospinal fluid and serum paraneoplastic studies (anti-Yo, Hu, Tr and GAD65 antibodies) were unremarkable. CT scan of the pelvis was done, revealing bilateral ovarian masses, although a PET scan and mammogram showed no additional lesions. She was treated with intravenous methylprednisolone, immunoglobulin and plasma exchange with minimal benefit. Both ovarian masses were surgically removed, and pathology was consistent with a mature left ovarian teratoma. Over the course of a year, she slowly regained her ability to walk and do daily activities. A whole body and brain PET scan showed no signs of active malignancy. Four years later, her symptoms were completely resolved and she was able to return to school. Surveillance ultrasound of the ovaries showed a dermoid cyst, but she continued to do well with no further recurrence.

Conclusions Our case suggests that acute cerebellar ataxia may be associated with an underlying ovarian teratoma. To our knowledge, this is the first report of such an association although another reversible disorder, anti-NMDA receptor encephalitis has been well-described. Our case may represent a new category of immune-mediated cerebellar ataxia that is reversible with treatment of the underlying tumor.

Authors/Disclosures
Jung E Park, MD, PhD (Dongguk University Ilsan Hospital) PRESENTER	No disclosure on file
Jai Perumal, MD	Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for T G therapeutics. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono.
Tsao-Wei Liang, MD (Thomas Jefferson University)	The institution of Dr. Liang has received research support from Bial R&D Investments S.A.. The institution of Dr. Liang has received research support from Parkinson's Foundation. The institution of Dr. Liang has received research support from AbbVie. The institution of Dr. Liang has received research support from Neuroderm. Dr. Liang has received publishing royalties from a publication relating to health care.

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