Cascone Francesca, Stella Federica, Barbato Christian, Minni Antonio, Attanasio Giuseppe
Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy.
Institute of Biochemistry and Cell Biology (IBBC-CNR), Sapienza University Rome, Policlinico Umberto I, 00161 Roma, Italy.
Brain Sci. 2025 Jun 11;15(6):628. doi: 10.3390/brainsci15060628.
Ocular flutter is an uncommon ophthalmic finding that may indicate paraneoplastic phenomena, and it is clinically characterized by intermittent bursts of conjugate, horizontal saccades without an intersaccadic interval. Ocular flutter must be differentiated from opsoclonus, which, although also characteristic of certain paraneoplastic syndromes, is instead defined by multidirectional saccades on both the horizontal and vertical planes. This report describes a very rare presentation of anti-Ri syndrome in a patient with an undiagnosed breast cancer, presenting with ocular flutter, dizziness, blurred vision, photophobia, and vomiting. Comprehensive evaluations, including contrast-enhanced brain Magnetic Resonance Imaging (MRI), brain Computed Tomography (CT) scan, ophthalmological assessment, viral serology, complete blood count and thyroid, renal coagulation, hepatic function assessments, vitamin D and B12 levels, were all normal. Upon excluding other potential etiologies for the neurological symptoms, a paraneoplastic origin was considered. Serological tests confirmed the presence of anti-Ri onconeural antibodies, and a whole-body CT scan identified nodules in the right breast. Despite surgical excision of the primary tumor and subsequent medical therapy, there was no improvement in the neurological symptoms. Follow-up evaluations at 2 months, 6 months, 1 year and 2 years revealed persistent vestibular and neurological symptoms, with serum tests remaining positive for anti-Ri antibodies and no clinical or radiological evidence of neoplastic recurrence.
眼球扑动是一种罕见的眼科表现，可能提示副肿瘤现象，其临床特征为共轭性水平扫视的间歇性发作，且无扫视间隔。眼球扑动必须与眼阵挛相鉴别，眼阵挛虽然也是某些副肿瘤综合征的特征，但它是由水平和垂直平面上的多向扫视所定义。本报告描述了一名未确诊乳腺癌患者出现的非常罕见的抗Ri综合征表现，患者伴有眼球扑动、头晕、视力模糊、畏光和呕吐。包括增强脑磁共振成像（MRI）、脑计算机断层扫描（CT）、眼科评估、病毒血清学、全血细胞计数以及甲状腺、肾脏凝血、肝功能评估、维生素D和B12水平在内的全面评估均正常。在排除神经系统症状的其他潜在病因后，考虑为副肿瘤起源。血清学检测证实存在抗Ri肿瘤神经抗体，全身CT扫描发现右乳有结节。尽管对原发肿瘤进行了手术切除并随后进行了药物治疗，但神经系统症状并无改善。在2个月、6个月、1年和2年时的随访评估显示，前庭和神经系统症状持续存在，血清检测抗Ri抗体仍为阳性，且无肿瘤复发的临床或影像学证据。
