Richard Fagbemigun, MD, MSc
Resident Physician
Yale Greenwich Hospital
Greenwich, Connecticut, United States
Brian Abarbanel, MD
Resident Physician
Shirley Ryan Ability Lab
Greenwich, Connecticut, United States
Priya Mhatre, MD MPH
Attending Physician
Shirley Ryan Ability Lab
Greenwich, Connecticut, United States
A 70-year-old woman diagnosed with cerebellitis due to a small cell neuroendocrine tumor
Case Description:
The patient initially presented to an acute care hospital with rapidly progressive dizziness, vertigo, slurred speech, and imbalance of one month duration. She was diagnosed with a small cell neuroendocrine tumor of unknown primary, with a likely secondary antibody-negative paraneoplastic cerebellitis. She was treated with chemotherapy (Carboplatin/Etoposide) and a course of steroids, resulting in modest improvement of her symptoms. She was subsequently discharged to an inpatient rehabilitation facility (IRF).
Discussions:
Upon admission to IRF, her exam was notable for instability in sit-to-stand testing; moderate, bilateral dysmetria on finger-nose-finger testing(L >R); and bilateral dysmetria on heel-knee-shin testing (R >L). After 2.5 weeks of intense physical and occupational therapy, she improved from supervision assist to independent for self-care activities of daily living, from maximum assist to supervision assist for transfers and from moderate assist to supervision assist for ambulation. Her instability and dysmetria also significantly improved by discharge. Although neuroendocrine tumor induced cerebellitis is an uncommon condition, the associated self-care and mobility impairments can improve with treatment in an IRF. This case underscores the importance of early recognition and comprehensive rehabilitation strategies in optimizing outcomes for patients with paraneoplastic cerebellitis, especially in the context of concurrent cancer treatment.
Conclusions:
Utilizing inpatient rehabilitation can serve as an effective approach to ameliorate the symptoms of paraneoplastic cerebellitis. This intervention has the potential to enhance the quality of life for patients, even in cases with no identifiable primary tumor.
