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Case Records of the Massachusetts General Hospital
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Volume 356:612-620 February 8, 2007 Number 6
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Case 4-2007 — A 56-Year-Old Woman with Rapidly Progressive Vertigo and Ataxia
Josep Dalmau, M.D., Ph.D., R. Gilberto Gonzalez, M.D., Ph.D., and Melinda F. Lerwill, M.D.

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Presentation of Case

A 56-year-old woman was admitted to the hospital because of rapidly progressive vertigo and ataxia.

The patient had been well until approximately 10 weeks before admission, when occasional dizziness and nausea occurred, followed during the next several weeks by increasing positional vertigo and severe vomiting. Antiemetic agents were administered, the vomiting resolved, and her dizziness improved. Shortly thereafter, slurred speech, rapidly progressive ataxia, and difficulty with ambulation developed.

Approximately 6 weeks before admission, the patient saw a physician at another facility. Cranial magnetic resonance imaging (MRI) showed an increased T2-weighted signal in the periventricular white matter that was thought . . . [Full Text of this Article]

Differential Diagnosis

Cerebrovascular Disease

Demyelinating Disorders

Sarcoidosis

Paraneoplastic Syndromes Affecting the Central Nervous System

            Immunologic Features of Paraneoplastic Syndromes

            Clinical Features of Paraneoplastic Cerebellar Degeneration

            Tumors Associated with Paraneoplastic Syndromes of the Central Nervous System

Summary

Clinical Diagnosis

Dr. Josep Dalmau's Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Division of Neuro-oncology, Department of Neurology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia (J.D.); the Departments of Radiology (R.G.G.) and Pathology (M.F.L.), Massachusetts General Hospital, Boston; and the Departments of Radiology (R.G.G.) and Pathology (M.F.L.), Harvard Medical School, Boston.



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