Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 79–81 79 Blackwell Publishing, Ltd. Case Report Gynaecology meets neurology Gynaecology meets neurology: Paraneoplastic cerebellar degeneration Russell LAND, Jonathan CARTER, Roger HOUGHTON, Ken ATKINSON and Christopher DALRYMPLE Royal Prince Alfred Hospital, Sydney, Australia Introduction Paraneoplastic syndromes (PNS) are defined as a constella- tion of symptoms involving non-metastatic systemic effects which accompany malignant disease. 1,2 Gynaecological tumours can manifest a variety of paraneoplastic sequelae including neurologic, haematopoietic, vascular, rheumato- logic, dermal and endocrine disorders. 1 Neurologic paraneo- plastic phenomena occur in less then 1:20 0000 of the population per year. 3 Cerebellar degeneration is a rare and frequently devastating paraneoplastic syndrome which can be associated with gynaecological malignancies amongst others. 4–6 Despite this rarity, over 50% of those patients over the age of 50 with subacute cerebellar degeneration will be associated with a paraneoplastic phenomena. 4 Overall 90% of all paraneoplastic cerebellar degeneration (PCD) is associated with either lymphoma, lung, breast, or ovarian cancers. 2,3 The two cases reported here demonstrate the marked variation in clinical outcomes, salient points in workup and treatment for patients with this difficult clinical scenario. Case 1 A 61-year-old multiparous patient presented with increasingly unsteady gait over recent weeks and increasing dysarthria noted in the preceding few days. A computerised tomography (CT) head scan was normal. She did not smoke or drink and her medical history included mild hypertension which was well controlled by medication. She had no other significant history. An examination revealed an unsteady widespread gait, nystagmus and mild dysarthria. Strength, tone and sensation were normal. She had dysdiadochokinesia. A general and gynaecological examination was otherwise unremarkable. Magnetic resonance imaging (MRI) with MRI angiography was normal. As part of her paraneoplastic workup, pelvic ultrasound, mammogram, and tumour markers (CA125/ CA19-9/CA15-3) were all within normal limits. Antineuronal antibody testing (including anti-Yo, Ri, and Hu) was positive for anti-Purkinje (anti-Yo) cell antibodies. A positron emission tomograph (PET) scan showed a glucose avid lesion within the large bowel at the splenic flexure and a much smaller focal abnormality in the left pelvis (Fig. 1). Despite colonoscopic removal of a 2-cm polyp from the splenic flexure, which proved to be a benign tubulovillous adenoma, she experienced ongoing deterioration of her speech and gait. At laparoscopy, 3 months after development of her initial symptoms, a focal abnormality less then 1 cm was noted on the fimbrial end of the left fallopian tube which was adherent to the sigmoid colon. There was no other abnormality seen throughout the peritoneal cavity. She underwent laparoscopic bilateral salpingo-oophorectomy and the histology confirmed fallopian tube serous adenocarci- noma. Endometrial curettings were normal. Her condition deteriorated despite tumor removal and a trial of plasmapheresis with worsening dysarthria, choking on fluids, vomiting and nausea, and head tremor. She died in palliative care 4 months following her presentation. Case 2 A 52-year-old female was investigated for cerebellar symp- toms of dysarthria, incoordination and ataxia, which had Figure 1 PET scan demonstrating colonic lesion in upper right images and small left adnexal lesion in lower left images. Correspondence: Russell Land, 63 Mars Street, Coorparoo, Queensland 4151, Australia. Email: rmland@bigpond.com Received 23 July 2004; accepted 26 August 2004.