A Patient Presenting With Nystagmus and Dysphagia

UPFRONT Case Section Editor: Larry Frohman, MD A Patient Presenting With Nystagmus and Dysphagia A previously healthy 86-year-old Caucasian man presented to the hospital with a 2-month history of progressive ataxia and bladder incontinence and new dysphagia for 2 days. A neuro-ophthalmologic examination was notable for bilateral downbeat nystagmus, and extensive work-up, including MRI brain, nutritional workup, and medication review, was unremarkable. Ultimately, given suspicion for a paraneoplastic etiology as a cause of his downbeat nystagmus and constellation of other symptoms, a neoplastic workup was initiated, and the patient was found to have metastatic Merkel Cell carcinoma and associated calcium channel P/Q antibodies confirming paraneoplastic cerebellar degeneration from Merkel Cell carcinoma. After initiation of intravenous steroids and e92 chemotherapy, the patient had significant improvement in his ocular symptoms. The case is available to download through the following link: https://journals.lww.com/jneuro-ophthalmology/Documents/ JNO%20Upfront%20Cases/UPFRONT%20Case%2023% 20-%20Nystagmus%20and%20Dysphagia.pptx. Christian A. Leal, MD, Andrew T. Melson, MD Department of Ophthalmology (CAL, ATM), Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma. Address correspondence to Christian A. Leal, MD, Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, 608 Stanton L Young Boulevard, Oklahoma City, OK 73104; E-mail: [e-mail] The authors report no conflicts of interest. UPFRONT Case: J Neuro-Ophthalmol 2023; 43: e92 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.