Neurológia pre prax 1/2023

Subacute cerebellar degeneration, or Antibodies as an enemy

Introduction and aim: Subacute cerebellar degeneration is one of the paraneoplastic neurological syndromes that occur in cancer diseases in which tumour cells express neuronal proteins, causing an immune response not only against the tumour, but also against the nervous system. Patient-produced onconeural antibodies attack and damage various parts of the nervous system, resulting in the development of a broad spectrum of neurological symptoms. Methods: We report the case of a 62-year-old woman with a history of cancer and advanced neurological cerebellar signs. Accordingly, after the exclusion of the most common causes of cerebellar syndrome (stroke, neurological infection), the diagnostic workup was aimed at identifying a paraneoplastic process that was confirmed by a high seropositivity of paraneoplastic anti-Yo antibodies (highly specific antibodies attacking the Purkinje cells of the cerebellum). Conclusion: The development of neurological symptoms in cancer patients should raise suspicion of a paraneoplastic process. Current treatment strategies allow to only minimally slow down the paraneoplastic process, and it is the treatment of the underlying cancer disease that remains essential.

Keywords: paraneoplastic syndrome, cerebellar degeneration, anti-Yo antibodies, onconeural antibodies