Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Recurrent ataxia and respiratory failure with probable paraneoplastic syndrome responsive to plasma exchange therapy

Toshiyuki Kondo, M.D.1), Ryosuke Igari, M.D., Ph.D.1), Hiroyasu Sato, M.D., Ph.D.1), Chifumi Iseki, M.D., Ph.D.1), Kenichi Ishizawa, M.D., Ph.D.2) and Kyoko Suzuki, M.D., Ph.D.1)3)

1)Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine
2)Department of Third Internal Medicine Division of Hematology and Cell Therapy, Yamagata University Faculty of Medicine
3)Present Address: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine

An 80-year-old male with prostatic adenocarcinoma who was treated with orchiectomy presented dysarthria and difficulty in walking. His symptoms subacutely progressed. Seven days later, he was non-ambulatory and was admitted to our hospital. He had poor vision and cerebellar ataxia of the lower extremities; however, his muscle strength, tendon reflexes, and sensory functions were preserved. Paraneoplastic retinopathy was diagnosed based on electroretinographic and visual field defect. Further, brain and spinal MRI, cerebral spinal fluid, and nerve conduction assessments were normal. These symptoms were followed by consciousness disturbance and respiratory failure; consequently, he required non-invasive positive pressure ventilation (NPPV) and tube feeding. Steroid pulse therapy and plasma exchange (PE) were performed. In response to the therapy, all these symptoms were relieved, and NPPV and tube feeding were withdrawn. However, the same symptoms occurred additional three times throughout the course of approximately 1 year. Each time, PE was the most effective treatment. Although paraneoplastic neurological syndrome associated with prostatic cancer is rare, immunotherapy could be a therapeutic choice to relive symptoms.
Full Text of this Article in Japanese PDF (1103K)

(CLINICA NEUROL, 59: 339|344, 2019)
key words: paraneoplastic neurological syndrome, prostate adenocarcinoma, subacute cerebellar degeneration, plasma exchange therapy

(Received: 2-Oct-18)