Superior cerebellar hyperintense sign on FLAIR-weighted magnetic resonance imaging in paraneoplastic cerebellar degeneration

Sinal hipertenso do vérmis cerebelar superior na sequência FLAIR em um paciente com degeneração cerebelar paraneoplásica

IMAGES IN NEUROLOGY

Superior cerebellar hyperintense sign on FLAIR-weighted magnetic resonance imaging in paraneoplastic cerebellar degeneration

Sinal hipertenso do vérmis cerebelar superior na sequência FLAIR em um paciente com degeneração cerebelar paraneoplásica

Marcelo de Melo Aragão; José Luiz Pedroso; Marcus Vinicius Cristino Albuquerque; Livia Almeida Dutra; Orlando Graziani Povoas Barsottini

Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo SP, Brazil

^{Correspondence}

A 59 year-old woman presented with 15 days history of progressive gait instability and slurred speech. She had recurrence of breast cancer diagnosed five years before. Neurological examination showed dysarthria and ataxia. Brain magnetic resonance imaging (MRI) presented hyperintense sign in the superior cerebellar vermis and upper cerebellar hemispheres, without atrophy (Figure). Cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis. Cerebellar degeneration is one of the most common neurological paraneoplastic syndromes. The most frequently associated tumors are: breast, ovary and lung cancer, and also lymphoma¹. Early brain MRI is frequently normal or shows a diffuse enlargement of cerebellar hemispheres; rarely, there are signal changes in the cerebellar cortex². After a few months, atrophy of the brainstem and cerebellum may appear.

Received 05 May 2012

Received in final form 03 September 2012

Accepted 10 September 2012

Conflict of interest: There is no conflict of interest to declare.

• 1. Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008;7:327-340.
• 2. de Andrés C, Esquivel A, de Villoria JG, Graus F, Sánchez-Ramón S. Unusual magnetic imaging and cerebrospinal fluid findings in paraneoplastic cerebellar degeneration: a sequential study. J Neurol Neurosurg Psychiatry 2006;77:562-568.

Publication Dates

• Publication in this collection
  03 Jan 2013
• Date of issue
  Dec 2012