Degeneración cerebelosa subaguda paraneoplásica: caso clínico

Introduccion y objetivo: La degeneracion cerebelosa paraneoplasica (DCP) es un sindrome poco frecuente y de dificil diagnostico. Suele presentarse meses o anos antes de la aparicion de una neoplasia y, menos frecuentemente, ocurre en pacientes con una neoplasia conocida o como forma de recidiva. Nuestro objetivo es describir un caso clinico diagnosticado en nuestra comunidad. Material y Metodo: Mujer de 49 anos, exfumadora de 23 paq/ano que a principios de ano acude a Urgencias por inestabilidad progresiva estando previamente asintomatica, por lo que es derivada a Neurologia y Otorrinolaringologia. Resultados: En la exploracion ORL presenta otoscopia y audiometria normales. Nistagmo de direccion cambiante. VVOR: ojos de muneca V-HIT con ganancias normales, no sacadas de refijacion. Tras la realizacion de pruebas complementarias se objetiva un nodulo pulmonar de 9mm y conglomerado adenopatico mediastinico. Ante la sospecha de neoplasia se realiza biopsia transbronquial con resultado de carcinoma microcitico. En inmunologia se detectaron anti CV2 positivo, estableciendose el diagnostico de ataxia cerebelosa subaguda paraneoplasica. Conclusiones: La evolucion de este sindrome provoca perdida neuronal irreversible siendo, por tanto, el diagnostico precoz y el tratamiento fundamentales en el pronostico. Introduction and objective: Paraneoplastic cerebellar degeneration is a rare syndrome and it is difficult to diagnose. It usually appears months or years before the onset of a malignant neoplasm and, less frequently, occurs in patients with a known neoplasm or as a form of recurrence. Our objective is to describe a clinical case diagnosed in our community. Material and Method: A 49-year-old woman, an ex-smoker of 23 pack/year who, at the beginning of the year, went to the Emergency Department due to progressive instability. She was previously asymptomatic and was referred to Neurology and Otolaryngology. Results: In the ENT exploration she presents normal otoscopy and audiometry. Direction changing nystagmus. VVOR: doll’s eyes V-HIT with normal gains, not taken out of refixation. After carrying out complementary tests, a pulmonary nodule of 9mm and mediastinal adenopathic conglomerate was observed. Due to the suspicious of neoplasia, a transbronchial biopsy was performed with the result of small cell carcinoma. In immunology, anti-CV2 positive was detected, establishing the diagnosis of paraneoplastic subacute cerebellar ataxia. Conclusions: The evolution of this syndrome causes irreversible neuronal loss, being, therefore, the precocious diagnosis and its treatment very important in the prognosis.