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A 74-year-old man with bronchial carcinoma comes to the clinic for review. He is seeing the oncologists soon for radiotherapy, but is concerned as his walking has deteriorated markedly over the past three weeks, with poor co-ordination, and frequent falls. Examination in the clinic reveals an ataxic gait with bilateral cerebellar signs on upper limb assessment.
Which of the following autoantibodies is most likely to be found in this patient?
Key Learning Point
Cerebellar degeneration is a well recognised paraneoplastic syndrome, and is associated with number of malignancies.
The answer is Anti-Hu. Anti-Hu, anti-Yo, anti-Ri and anti-Tr antibodies are all associated with paraneoplastic cerebellar degeneration. Anti-Hu and Ri antibodies are associated with small cell lung cancer, Yo antibodies are associated with breast and gynaecological cancers, and Tr antibodies are associated with Hodgkin's lymphoma. Treatment of the underlying tumour reduces autoantibody formation, and may improve symptoms.
Anti-amphiphysin antibodies are associated with stiff person syndrome and encephalomyelitis, and are associated with breast and lung cancer. Anti-GABA (B) antibodies are seen in small cell lung cancer and are associated with seizures and limbic encephalitis. Anti-mGluR1 antibodies are seen in Hodgkin's lymphoma and are associated with cerebellar degeneration. Anti-VGCC antibodies are of course related to the Lambert-Eaton myasthenic syndrome.