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 Correspondence: José Luiz Pedroso Rua Botucatu 740 04023-900 São Paulo SP - Brasil E-mail: email@example.com
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.
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03 Jan 2013
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