Tunis Med. 2020 Nov;98(11):869-872.
Neurological presentation of paraneoplastic syndromes is rare. They are often difficult to diagnose, especially when they precede the diagnosis of cancer. Hodgkin's lymphoma is associated with several paraneoplastic neurological syndromes such as cerebellar degeneration and dermato/polymyositis. Peripheral vestibular syndrome is uncommon presentation of these paraneoplastic syndromes. We report the case of a 52-year-old man with no prior medical history who presented to the otolaryngology clinic with vertigo precipitated by nystagmus, nausea and weight loss. Diagnostic workup revealed a nodular sclerosing variant of Hodgkin's lymphoma without paraneoplastic antibodies. The patient's symptoms resolved after institution of chemotherapy, radiotherapy and vestibular rehabilitation. Hodgkin's lymphoma has been reported to be associated with many paraneoplastic syndromes with neurological presentation in which peripheral vestibular syndrome is an uncommon one. Sometimes it can be the only presenting symptom of an unknown Hodgkin's lymphoma. This create a real diagnostic challenge for clinicians specially when paraneoplastic antibodies are negative. Chemotherapy and radiotherapy as treatment of the underlying disease is of a big benefit if started as early as possible.
副肿瘤综合征的神经表现较为罕见。这些疾病常常难以诊断，尤其是在癌症诊断之前。霍奇金淋巴瘤与多种副肿瘤神经系统综合征相关，如小脑变性和皮肌炎。周围性前庭综合征是这些副肿瘤综合征的不常见表现。我们报告了一例 52 岁男性病例，无既往病史，因眼球震颤、恶心和体重减轻而就诊耳鼻喉科门诊，表现为眩晕。诊断性检查显示为霍奇金淋巴瘤结节性硬化型，无副肿瘤抗体。患者的症状在接受化疗、放疗和前庭康复治疗后得到缓解。据报道，霍奇金淋巴瘤与许多副肿瘤综合征相关，这些综合征以神经系统表现为特征，其中周围性前庭综合征较为罕见。有时它可能是未知霍奇金淋巴瘤的唯一表现症状。这给临床医生带来了真正的诊断挑战，特别是当副肿瘤抗体为阴性时。如果尽早开始治疗潜在疾病（如化疗和放疗），对患者有很大的益处。
