| 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 |
| References |
1. Christoph Kellinghaus, Joerg Kraus, Franz Blaes, Darius G. Nabavi, Wolf R. Schäbitz.. CRMP-5- Autoantibodies in Testicular CancerAssociated with Limbic Encephalitis andChoreiform Dyskinesias. Eur Neurol 2007;57:241-243. 2. Luis Batallera, Josep Dalmaub. Neuro-ophthalmology and paraneoplastic syndromes. Current Opinion in Neurology 2004, 17:3-8. 3. Francesc Grausa and Josep Dalmau. Paraneoplastic neurological syndromes. Curr Opin Neurol 2012, 25:000-000. 4. Bonnie L. Balzer, MD, PhD and Thomas M. Ulbright, MD. Spontaneous Regression of Testicular Germ Cell Tumors. An Analysis of 42 Cases.Am J Surg Pathol -Volume 30, Number 7, July 2006. 5. Javier C. Angulo, Javier González, Nuria Rodríguez, Emilio Hernández, Carlos Núñez, Jose M. Rodríguez- Barbero, Alicia Santana and José I. López.Clinicopathological Study of Regressed Testicular Tumors (Apparent Extragonadal Germ Cell Neoplasms). The Journal of Urology.Vol. 182, 2303-2310, November 2009. |
| 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 - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6313 |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6hh9gn2 |
| Setname |
ehsl_novel_fbw |
| ID |
179240 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6hh9gn2 |
