2001 Volume 60 Issue 1 Pages 16-23
We encountered two patients with paraneoplastic neurologic syndrome who visited our ENT clinic complaining of vertigo. The first patient was a 73-year-old woman who was admitted to our hospital because of dysequilibrium and dysarthria of subacute onset. Chest CT showed swelling of the mediastinal and right hilar lymphnodes. Pathological examination of the hilar lymphnodes taken by thoracotomy revealed small cell carcinoma of the lung. Brain CT and brain MRI were normal. Cytological study of the cerebrospinal fluid was class I. Paraneoplastic cerebellar degeneration was diagnosed. Neuro-otological examinations revealed: 1) gaze nystagmus on both right and left lateral gaze, 2) saccadic pursuit, 3) hypometric saccades, 4) diminished caloric nystagmus and 5) decreased visual suppression of caloric nystagmus. Treatment with plasmapheresis was successful to improve limb/truncal ataxia, dysarthria, and neuro-otological findings. The second patient was a 54-year-old woman who had had surgical treatment 3 years before for ovarian cancer. She visited our ENT clinic because of vigorous vertigo and diplopia of sudden onset. Neurological examinations revealed reduced deep tendon reflexes and neuro-otological examinations revealed: 1) bilateral abducens nerve palsy, 2) gaze nystagmus on both right and left lateral gaze, 3) saccadic pursuit, and 4) markedly diminished caloric nystagmus. Gynecological examinations revealed recurrent ovarian cancer. Brain CT and brain MRI were normal. Cytological study of the cerebrospinal fluid was class I. Paraneoplastic brainstem encephalitis was diagnosed. Steroid pulse therapy improved her subjective symptoms and neuro-otological findings. We emphasize that the early induction of plasmapheresis or steroid pulse therapy should be used to treat patients with paraneoplastic neurologic syndrome and that neuro-oto-logical examinations are indispensable for quantitatively assessing the effectiveness of these treatments.
