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Paraneoplastic Ri Syndrome
Case Study A
A 69-year-old woman with a fifty pack per year smoking history awoke one morning to find that her vision was jumping. When she watched television, the image moved rapidly from side to side, and she was unable to read the newspaper. At approximately the same time, she noted that on hearing a loud noise, for example a car backfiring, her whole body would jerk. Several days later, the patient found that she had a progressive gait difficulty, first stumbling with poor balance while walking, and culminating several days later in an inability to balance while simply standing. She was referred to a neurologist, who diagnosed truncal ataxia with opsoclonus/myoclonus. A serum test for the Ri autoantibody was positive, and a search for a malignancy led to the identification of a single lung nodule which proved to be a small cell lung cancer upon biopsy; a metastatic work-up was negative. She received a multidrug chemotherapy regimen. After three cycles of treatment her opsoclonus/myoclonus resolved and her gait was markedly improved.
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