Double Vision? - Give Your Head a Shake

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Identifier walsh_2013_s3_c3-2
Title Double Vision? - Give Your Head a Shake
Creator Vivek Patel, Danah Albreiki
Subject Paraneoplastic; Cerebellum; CRMP-5; Nystagmus; Diplopia
History 3 month history of constant binocular oblique diplopia with mild worsening, progressive disequilibrium, and a wide based gait. No vertigo, loss of coordination, loss of vision or oscillpsia, hearing loss, or tinnitus. No history of cancer, hypothyroidism, GI malabsorption or anemia. Occupational history: Food service industry. Diet: Normal Non smoker, non drinker, no illicit drug use. Negative for spinocerebellar ataxias.
Pathology Regressed testicular cancer
Disease/Diagnosis Paraneoplastic cerebellar degeneration in association with CRMP-5 antibodies and testicular cancer.
Clinical VA 20/20 OU. Afferent neuro-op exam normal. EOM: +2 left inferior oblique overaction, -1 under action of Left superior oblique. 16LHt on primary gaze, 18 LHt on right gaze and 23LHt on Left head tilt. No subjective torsion but fundus exam shows marked excylotorsion of right eye, mild incyclo of left. No change in deviation upon lying supine. Nystagmus -- primary: high frequency low amplitude right beating and torsional nystagmus. Right gaze: right beating nystagmus, occasional torsional beats. Upbeat nystagmus on upgaze. Left beating in left gaze. Occasional rightward beats on downgaze, with no downbeat nystagmus. Smooth pursuit and saccades well calibrated. Horizontal head shaking showed reproducible right beating nystagmus sustained for 15 sec. Cerebellar exam: Mildly wide based gait -Tandem gait: difficult however no fall preference to one side or other. No appendicular ataxia.
Presenting Symptom 54 year old gentlemen referred with diplopia.
Neuroimaging CT Scan
Date 2013-02-10
Language eng
Format video/mp4
Type Image/MovingImage
Source 45th Annual Frank Walsh Society Meeting
Relation is Part of Case presented at the NANOS 2013 Walsh Session, February 10
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Rights Management Copyright 2013. For further information regarding the rights to this collection, please visit:
ARK ark:/87278/s6hh9gn2
Contributor Primary Bhatti, M Tariq
Contributor Secondary Thurtell, Matthew J
Setname ehsl_novel_fbw
ID 179240
Reference URL