A brain MRI, ordered by her primary care doctor, was normal.
The patient is in no acute distress, and her mental status is normal. Her cardiac, respiratory, and abdominal examinations are also normal.
On neurological examination, strength was 5/5 in all 4 extremities and sensory exam was normal to all modalities. She had dysmetria on finger to nose testing bilaterally, and the right side is worse than the left. Her cranial nerve examination is normal with the exception of bilateral nystagmus, which is worse when looking to the right.
She reports that she has adopted a wide-based gait to compensate for her loss of balance. She is completely unable to do a Romberg test or walk heel to toe due to poor balance.
Her complete blood count (CBC) and electrolyte laboratory studies are normal. Her neurologist orders a Western blot study to test for the presence of 3 antineuronal nuclear autoantibodies (ANNA, aka anti-Hu; anti-Ri; and anti-Yo). The anti-Yo test is positive, the anti-Hu and anti-Ri tests are negative. A chest CT and an abdominal and pelvic CT are normal.
1. Aydin Ç, Çelik ŞY, İçöz S, et al. Prognostic factors in anti-neuronal antibody positive patients. Noro Psikiyatr Ars. 2018;55:189-194.
2. Venkatraman A, Opal P. Paraneoplastic cerebellar degeneration with anti-Yo antibodies: a review. Ann Clin Transl Neurol. 2016;3:655-663.