2021 Volume 38 Issue 1 Pages 57-60
A 71–year–old man presented with dizziness and gait disturbance. On admission, his Scale for Assessment and Rating of Ataxia (SARA) score was 21. Cerebrospinal fluid examination revealed five oligoclonal bands. Although magnetic resonance imaging (MRI) of the brain showed slight cerebellar atrophy, and single–photon emission computed tomography (SPECT) showed no reduction in cerebellar blood flow. Computed tomography (CT) of the chest showed a lesion at the S6 area of the left inferior lobe. Fluorodeoxyglucose positron emission tomography (FDG–PET) demonstrated abnormal 18F–FDG uptake not only in this lesion, but also in the tracheal bifurcation and left adrenal gland. Bronchoscopic biopsy of the tracheal bifurcation lesion revealed combined small cell carcinoma. Blood examination revealed anti–P/Q–type voltage–gated calcium channel (VGCC) antibodies, and he was diagnosed with paraneoplastic cerebellar degeneration associated with lung small cell carcinoma. He was started on chemotherapy for lung small cell carcinoma and given an intravenous injection of immunoglobulin for cerebellar ataxia. After one year, a CT scan of the chest showed that the tumors had disappeared completely, but his cerebellar ataxia remained almost unchanged, and anti–VGCC antibodies were still detected in his blood. Plasma exchange and steroid pulse therapy did not help his cerebellar ataxia. His SARA score changed from 21 to 20.5 during the 5 years since the onset of the disease.
