The Feb. 16, 2021 session of Duke Medicine LEADS featured a discussion led by Yolanda Guzman, MD; Matthew Harbrecht, MD; and Jonathan Komisar, MD, "71-year-old male with dizziness, nausea, and difficulty walking."
Expert consultants included, Christopher Eckstein, MD; Thomas Holland, MD; and Neal Ready, MD, PhD, who weighed in for the diagnostic reasoning and discussion.
Here are pearls and takeaways from the session:
- We learned about a 71-year-old male who presented with dizziness with opsoclonus on exam, found to have an anti-Hu paraneoplastic syndrome secondary to small cell lung cancer.
- Opsoclonus is characterized by involuntary, arrhythmic, multidirectional, high amplitude conjugate saccades occurring in all directions and without an inter-saccadic interval.
- Up to 20% of adult cases of opsoclonus are associated with paraneoplastic syndromes.
- Small cell lung cancer is the common malignancy associated with paraneoplastic syndromes, with 90% of patients with paraneoplastic syndromes having metastatic disease at the time of diagnosis.
- Treatment of neurologic paraneoplastic syndromes includes treating the underlying malignancy along with plasmapheresis and/or IVIG.
- Prognosis is largely driven by target antigens - antibodies targeting intracellular antigens have a poor treatment response; antibodies targeting surface antigens have a better treatment response.
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.
