Soares Ryan, Mittapalli Amrutha, Ramakrishnan Manju, Farooq Umar
Internal Medicine, St John's College, Philadelphia, USA.
Internal Medicine, Knights Medical Associates, Philadelphia, USA.
Cureus. 2022 Aug 25;14(8):e28417. doi: 10.7759/cureus.28417. eCollection 2022 Aug.
Breast cancer can rarely present with or be preceded by paraneoplastic syndromes such as opsoclonus-myoclonus syndrome (OMS). OMS is a rare neurological syndrome that commonly presents with symptoms of rapid, chaotic eye movements (opsoclonus), jerking involuntary muscle movements (myoclonus) and is frequently associated with ataxia. We describe a case of a woman in her early 50s who presented to the emergency room (ER) with vertigo, jerking movements, loss of fine motor skills and gait abnormalities. She was initially thought to have likely vestibular neuritis and was treated symptomatically and discharged home. However, the symptoms persisted and she presented once again to the ER, at which time she also incidentally discovered a lump in her breast. This led to her being investigated more extensively leading to a diagnosis of underlying primary breast cancer. Based on her neurological clinical findings, she was diagnosed with onconeural antibody negative OMS. Treatment of her underlying malignancy led to a significant improvement in her symptoms. Paraneoplastic neurological syndromes (PNSs) are an important differential diagnosis to consider in patients presenting with persistent, treatment-resistant and non-specific neurological symptoms. Any suspicion of the same should prompt a search for an underlying malignancy that could greatly influence patient outcomes.
乳腺癌很少会伴有副肿瘤综合征，如眼阵挛-肌阵挛综合征（OMS），或在其之前出现。OMS是一种罕见的神经系统综合征，通常表现为快速、混乱的眼球运动（眼阵挛）、肌肉抽搐性不自主运动（肌阵挛），并常伴有共济失调。我们描述了一例50岁出头的女性病例，她因眩晕、抽搐运动、精细运动技能丧失和步态异常前往急诊室就诊。她最初被认为可能患有前庭神经炎，接受了对症治疗后出院回家。然而，症状持续存在，她再次前往急诊室，此时她偶然发现乳房有一个肿块。这促使对她进行更广泛的检查，最终诊断为潜在的原发性乳腺癌。根据她的神经学临床检查结果，她被诊断为肿瘤相关性神经抗体阴性的OMS。对其潜在恶性肿瘤的治疗使其症状有了显著改善。副肿瘤性神经系统综合征（PNSs）是在出现持续、难治性和非特异性神经症状的患者中需要考虑的重要鉴别诊断。任何对此类综合征的怀疑都应促使寻找可能极大影响患者预后的潜在恶性肿瘤。
