Paraneoplastic cerebellar degeneration. A clinical and CT study

Six patients developed a pancerebellar syndrome with symptoms preceding the diagnosis of neoplasia in five (median - 4 months) and following in one (2 years). In all patients, the initial cranial computed tomographic (CT) scans were normal. Five patients had repeat CTs and of these three were abnormal; cerebellar atrophy appearing 7 to 25 months following the initial CT. Median follow-up was 31 months (range 12-84 months) without evidence of CNS metastatic disease. In five of six patients the neurologic impairment did not progress. One patient's neurologic signs improved markedly with mantle radiation therapy of her Hodgkin's disease. An initially negative CT does not preclude the diagnosis of remote effect cerebellar atrophy. Paraneoplastic cerebellar degeneration is a self-limited nonprogressive process in the majority of patients.