Bipolar disorder associated with paraneoplastic cerebellar degeneration: a case report.
The National Hospital For Neurology and Neurosurgery, Queens Square, London, UK.
We Present a case report of a patient who suffers from Paraneoplastic cerebellar degeneration (PCD) secondary to which the patient, a young woman, developed Bipolar Affective Disorder. Here we focus on the mental health aspects of this case.
- [PubMed – indexed for MEDLINE]Paraneoplastic cerebellar degeneration (PCD) is a paraneoplastic syndrome associated with lung, ovarian, breast, and other cancers.As is the case with other paraneoplastic syndromes, PCD is believed to be due to an autoimmune reaction targeted against components of the central nervous system (in PCD, this is specifically Purkinje cells). It is thought to be triggered when tumor cells (in PCD, most commonly ovarian or breast cancer) express a protein normally expressed in the brain (in PCD, this is the Purkinje neuronal protein termed cdr2). This is believed to trigger an anti-tumor immune response that may be clinically significant, but also an anti-neuronal immune response. PCD patients harbor an anti-neuronal antibody known as anti-Yo (named after the first two letters of the index patient). PCD may be associated with other tumors–when associated with small cell lung cancer, it is associated with an antibody termed “anti-Hu” (more commonly associated with paraneoplastic subacute sensory neuropathy and/or limbic encephalitis).
The clinical cerebellar ataxia evident in patients with PCD are caused by Purkinje neuronal loss in the cerebellum; it is manifested by dysarthria, limb and gait ataxia, and nystagmus. Radiologic imaging occasionally reveals cerebellar atrophy. Other paraneoplastic antibodies may be associated with PCD symptoms, including anti-Tr and antibodies to glutamate receptor