Case Report

A case of paraneoplastic syndrome definitively diagnosed from progressive ataxia during rehabilitation

Yoshitomo Sato, MD, Kiyohumi Ohi, MD, Akira Takahashi, MD, Hanae Murakami, MD, Miyuki Murata, MD, Tatunori Natori, MD, Hisashi Yonezawa, MD, Yasuo Terayama, MD
Jpn J Compr Rehabil Sci 6: 113-117, 2015

We report a case of paraneoplastic syndrome (PNS) definitively diagnosed after the patientfs previous doctor requested a detailed examination when her ataxia worsened during rehabilitation in the recovery stage. Exacerbation of limb ataxia and positive results for anti-neural antibodies were suggestive of PNS, but no clear neoplastic lesion could be identified on systematic examination, so the patient was admitted to the recovery-stage rehabilitation ward without definitive diagnosis. She underwent another detailed examination when ataxia worsened after starting rehabilitation, leading to a diagnosis of gynecological malignant tumor based on fluorodeoxyglucose positron emission tomography (FDG-PET). The patient underwent hysterectomy and bilateral salpingo-oophorectomy, which confirmed the presence of PNS concomitant with serous adenocarcinoma of the left ovary. Although the numbers are low, patients on recovery-stage rehabilitation wards usually have unstable neurological disorders. Anti-Yo antibody-positive PNS often shows a poor prognosis, and when ataxia worsens after starting rehabilitation, differentiating PNS early to make a definitive diagnosis can influence the prognosis. We report this rare case of PNS.

Key words: paraneoplastic syndrome, ataxia, CA- 125, anti-Yo antibody, rehabilitation in recovery stage

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